Provider Demographics
NPI:1174620447
Name:CONSULTANTS INTERNAL MEDICINE, P.A.
Entity type:Organization
Organization Name:CONSULTANTS INTERNAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BINA
Authorized Official - Suffix:
Authorized Official - Credentials:MHHSA
Authorized Official - Phone:952-915-3939
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 385
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2111
Mailing Address - Country:US
Mailing Address - Phone:952-920-2761
Mailing Address - Fax:952-920-0383
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 385
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2111
Practice Address - Country:US
Practice Address - Phone:952-920-2761
Practice Address - Fax:952-920-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00041Medicare ID - Type Unspecified