Organization
PROACTIVE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN BURDASH (C.E.O.)
(651) 778-0080
Entity
Organization
Contact information
Practice address
101 5TH ST E, SUITE 227, SAINT PAUL, MN 55101-1898
(651) 778-0080
(651) 778-0195
Mailing address
101 5TH ST E, SUITE 227, SAINT PAUL, MN 55101-1898
(651) 778-0080
(651) 778-0195
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
41988
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891058384
—
MN
Enumeration date
06/19/2012
Last updated
09/27/2012
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