Columbia Park Medical Group, PA

NPI #1205933611 in Fridley, Minnesota

Provider Information

NPI Number: 1205933611
Entity Type: Organization
Organization Name: Columbia Park Medical Group, PA
Subpart: Yes (part of a larger organization)
Parent Organization: COLUMBIA PARK MEDICAL GROUP
Primary Specialty: Eyewear Supplier
Enumeration Date: Sep 20, 2006
Last Updated: Nov 13, 2007

Practice Location

Address: 6341 UNIVERSITY AVE NE
City: Fridley
State: Minnesota
ZIP Code: 55432-4946
Phone: (763) 572-5718

Authorized Official

Name: JOEN V CONDON
Title: CHIEF FINANCIAL OFFICER
Phone: (763) 586-5839

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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