Organization
MINNESOTA DOC
Active
Organization
MINNESOTA DOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A PAULSON MD (MEDICAL DIRECTOR)
(612) 390-4747
Entity
Organization
Contact information
Practice address
1450 ENERGY PARK DR, SAINT PAUL, MN 55108-5274
(651) 361-7200
(651) 642-0223
Mailing address
1450 ENERGY PARK DR, SAINT PAUL, MN 55108-5274
(651) 361-7200
(651) 642-0223
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
R172606-6
MN
Other
Enumeration date
12/24/2014
Last updated
03/31/2015
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