Child and Teen Medical Center

NPI #1225158520 in Blaine, Minnesota

Provider Information

NPI Number
1225158520
Entity Type
Organization
Organization Name
Child and Teen Medical Center
Primary Specialty
Pediatrics
Enumeration Date
Mar 30, 2007
Last Updated
Aug 24, 2021

Practice Location

Address
11107 ULYSSES ST NE STE 100
City
Blaine
ZIP Code
55434-4184
Phone
(763) 333-7733

Authorized Official

Name
MRS. ANGELA MARIE BENNETT, BA
Title
PRACTIC ADMINISTRATOR
Phone
(763) 333-7755

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Medical SpecialtyMedical Specialty
Pediatrics

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