Organization
NATIVE AMERICAN COMMUNITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYDIA B CAROS DO (CEO)
(612) 872-8086
Entity
Organization
Contact information
Practice address
1213 E FRANKLIN AVE, MINNEAPOLIS, MN 55404-2923
(612) 872-8086
(612) 872-8547
Mailing address
1213 E FRANKLIN AVE, MINNEAPOLIS, MN 55404-2923
(612) 872-8086
(612) 872-8547
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731188500
—
MN
Enumeration date
01/09/2007
Last updated
09/16/2015
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