Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2006-11-30
- Last updated
- 2008-06-25
Specialties
Licenses
- License MN
- 3596
Location
- Practice location
- 13635 NORTHDALE BLVD
- City
- ROGERS MN
- Postal code
- 553742142
- Phone
- 763-428-1105
Organization contact
- Name
- RICHARD WILLIAMS
- Title
- Owner
- Phone
- 7635330654
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.