NPIMap

Organization Active NPI

Minneapolis Integrative Medicine Center, LLC

  • General Practice Physician
  • Wayzata, MN
National Provider Identifier
1447857230
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MINNEAPOLIS INTEGRATIVE MEDICINE CENTER, LLC
Practice address
1120 Wayzata Blvd E Ste 110
Wayzata, MN 55391-1984
Phone
(952) 222-7670
Fax
(763) 210-6809
NPI assigned
Oct 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Dr. Cassandra Wilder, NMDNPI 1881104693
Title
Owner
Phone
(952) 222-7670

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1120 Wayzata Blvd E Ste 110
Wayzata, MN 55391-1984

Mailing address

1120 Wayzata Blvd E Ste 110
Wayzata, MN 55391-1984
Phone (952) 222-7670

National Provider Directory

National Provider Directory

Locations

1120 Wayzata Blvd E
Ste 110
Wayzata, MN 55391
Phone (952) 222-7670

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1447857230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 WAYZATA BLVD E STE 110",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911984",
            "telephone_number": "952-222-7670",
            "fax_number": "763-210-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 WAYZATA BLVD E STE 110",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911984",
            "telephone_number": "952-222-7670",
            "fax_number": "763-210-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNEAPOLIS INTEGRATIVE MEDICINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-05",
        "last_updated": "2024-05-08",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "WILDER",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-222-7670",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "NMD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayzata, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.