Organization
MINNESOTA PERSONALIZED MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A PLOTNIKOFF MD (OWNER/FOUNDER)
(612) 345-5029
Entity
Organization
Contact information
Practice address
1409 WILLOW ST STE 501, MINNEAPOLIS, MN 55403-3288
(612) 345-5029
(612) 392-3957
Mailing address
1409 WILLOW ST STE 501, MINNEAPOLIS, MN 55403-3288
(612) 345-5029
(612) 392-3957
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34265
MEDICAL LICENSE
MN
01
—
43318
MEDICAL LICENSE
MN
01
—
47498
MEDICAL LICENSE
MN
Enumeration date
10/07/2021
Last updated
10/07/2021
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