Mina Medical Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MINA MEDICAL CLINIC LLC

Practice address

1690 Silver Lake Road NW
New Brighton, MN 55112

Phone

(612) 274-4380

NPI assigned

Aug 5, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Idiris Esse, MD

Title

Medical Director

Phone

(612) 274-4380

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659657600000",
    "number": "1457088809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6417 PENN AVE S STE 8",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554231196",
            "telephone_number": "612-274-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 SILVER LAKE ROAD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "55112",
            "telephone_number": "612-274-4380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINA MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "ESSE",
        "authorized_official_first_name": "IDIRIS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "612-274-4380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.