Organization
MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC
Active
Parent organization
MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC
Other names
Maple Grove Imaging Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC
Authorized official
KRISTEN CARLSON (CREDENTIALING)
(763) 398-2207
Entity
Organization
Contact information
Practice address
9855 HOSPITAL DRIVE, #105, MAPLE GROVE, MN 55369-4776
(763) 559-2171
(763) 398-4401
Mailing address
9855 HOSPITAL DRIVE, #150, MAPLE GROVE, MN 55369-4776
(763) 559-2171
(763) 398-6364
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1601988
MEDICA
—
01
—
342S2MI
BCBS
—
05
—
420012800
—
MN
Enumeration date
08/09/2005
Last updated
11/15/2019
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