Organization
CENTER FOR PRIMARY CARE AND REHABILITATION, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELENA LEV POLUKHIN MD, PHD (OWNER/MEDICAL DIRECTOR)
(651) 789-8022
Entity
Organization
Contact information
Practice address
880 BLUE GENTIAN RD STE 165, EAGAN, MN 55121-1772
(651) 789-8022
(651) 789-8028
Mailing address
3006 FRANK ST, MAPLEWOOD, MN 55109-5501
(651) 789-8022
(651) 789-8028
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
45600
MN
Other
Enumeration date
08/12/2011
Last updated
08/12/2011
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