Provider Demographics
NPI:1942524103
Name:SPECIALTY CARE GROUP, LLC
Entity type:Organization
Organization Name:SPECIALTY CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DANICA
Authorized Official - Middle Name:SONG
Authorized Official - Last Name:DOBEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-925-5008
Mailing Address - Street 1:2113 GIRARD AVE. S.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2547
Mailing Address - Country:US
Mailing Address - Phone:612-925-5008
Mailing Address - Fax:
Practice Address - Street 1:2113 GIRARD AVE S STE 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2547
Practice Address - Country:US
Practice Address - Phone:612-925-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty