| Organization Name: | ALLINA MEDICAL CLINIC |
| NPI Number: | 1730529983 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH PAULUS (COO) |
| Mailing Address: | 3007 Mustang Dr Madison Lake |
| State: | MN US |
| Postal Code: | 560639347 |
| Phone Number: | 5074569279 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2013 |
| NPI Last Update Date: | 07/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 1925 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |