Minor Medical Squad Pllc - Medicare Primary Care in St Louis Park, MN

Minor Medical Squad Pllc is a medicare enrolled primary clinic (Clinic/center - Community Health) in St Louis Park, Minnesota. The current practice location for Minor Medical Squad Pllc is 5775 Wayzata Blvd Ste 700, St Louis Park, Minnesota. For appointments, you can reach them via phone at (612) 504-6160. The mailing address for Minor Medical Squad Pllc is 826 Trenton Ln N, Plymouth, Minnesota and phone number is (612) 805-8676.

Minor Medical Squad Pllc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1821646985. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (612) 504-6160.

Contact Information

Minor Medical Squad Pllc
5775 Wayzata Blvd Ste 700
St Louis Park
MN 55416-1233
(612) 504-6160
(855) 818-2050

Primary Care Clinic Profile

Full NameMinor Medical Squad Pllc
SpecialityClinic/Center
Location5775 Wayzata Blvd Ste 700, St Louis Park, Minnesota
Authorized Official Name and PositionMichael Vito Dimucci (OWNER, FAMILY NURSE PRACTITIONER)
Authorized Official Contact6128058676
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Minor Medical Squad Pllc
826 Trenton Ln N
Plymouth
MN 55441-4496

Ph: (612) 805-8676
Minor Medical Squad Pllc
5775 Wayzata Blvd Ste 700
St Louis Park
MN 55416-1233

Ph: (612) 504-6160

NPI Details:

NPI Number1821646985
Provider Enumeration Date08/30/2019
Last Update Date09/30/2022

Medicare PECOS Information:

Medicare PECOS PAC ID4284063975
Medicare Enrollment IDO20200331003589

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Medical Identifiers

Medical identifiers for Minor Medical Squad Pllc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1821646985NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QC1500XClinic/center - Community Health (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Minor Medical Squad Pllc acts as a billing entity for following providers:
Provider NameMichael Vito Dimucci
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1083694806
PECOS PAC ID: 1759286842
Enrollment ID: I20031203000064

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Provider NameKumba U Kanu
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1194021766
PECOS PAC ID: 4486945169
Enrollment ID: I20160628001210

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› Verified 1 days ago


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