Zenith Medical Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

46773 Issued in MN

Legal business name

ZENITH MEDICAL CLINIC

Practice address

6800 78TH Ave N
Suite 110
Brooklyn Park, MN 55445-2758

Phone

(763) 503-1122

Fax

(763) 503-1127

NPI assigned

Mar 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Larbi-Odam, M.D.

Title

Owner

Phone

(763) 503-1122

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366569782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 78TH AVE N",
            "address_2": "SUITE 110",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452758",
            "telephone_number": "763-503-1122",
            "fax_number": "763-503-1127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 78TH AVE N",
            "address_2": "SUITE 110",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452758",
            "telephone_number": "763-503-1122",
            "fax_number": "763-503-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZENITH MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARBI-ODAM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-503-1122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "46773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1457311409",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.