State of Minnesota Minnesota Management and Budget
NPI #1588360903 in Minneapolis, Minnesota
Provider Information
- NPI Number
- 1588360903
- Entity Type
- Organization
- Organization Name
- State of Minnesota Minnesota Management and Budget
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- STATE OF MINNESOTA MINNESOTA MANAGE
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Feb 7, 2023
- Last Updated
- Dec 3, 2024
Practice Location
- Address
- 5101 MINNEHAHA AVE. S
- City
- Minneapolis
- State
- Minnesota
- ZIP Code
- 55417-1647
- Phone
- (612) 548-5733
Authorized Official
- Name
- SIMONE RENEE HOGAN
- Title
- MDVA HEALTHCARE OPERATIONS DIRECTOR
- Phone
- (612) 505-4110
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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