| Organization Name: | LITTLE CANADA MEDICAL CLINIC |
| NPI Number: | 1174836597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES WILLIAM ALLAN (PRESIDENT) |
| Mailing Address: | 75 Little Canada Rd W Little Canada |
| State: | MN US |
| Postal Code: | 551171362 |
| Phone Number: | 6514811119 |
| Fax Number: | 6514811476 |
| NPI Enumeration Date: | 07/15/2010 |
| NPI Last Update Date: | 07/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 20780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |