Gray Matter Partners

NPI 1083987291 - Clinic/Center - 261QM0855X

NPI Details
NPI 1083987291
Enumeration Date 02/18/2012
Last Updated 02/18/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name MARK THEODORE MARK
Position CLINICAL DIRECTOR
Phone (612) 716-3925
Fax
Practice Location
16809 260TH AVE
MC GRATH MN, 56350-4538, US
Phone (612) 716-3925
Fax
Business Location
16809 260TH AVE
MC GRATH MN, 56350-4538, US
Phone (612) 716-3925
Fax
Toxanomy
Taxonomy Code 261QM0855X
License State Minnesota
License Number LP4963
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According to our database, Gray Matter Partners NPI is 1083987291, taxonomy code is 261QM0855X and license number is LP4963, license state is located at Minnesota. Gray Matter Partners physically located at 16809 260th Ave, Mc Grath MN, 56350-4538. NPI Number 1033115704 has the healthcare provider type.

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1083987291 NPI number is provided on an as is basis without warranty of any kind. 1083987291 is maintained by the National Plan & Provider Enumeration System. The contents of Gray Matter Partners are for informational purposes only.