Internal Medicine Consultants

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

47816 Issued in MN

Legal business name

INTERNAL MEDICINE CONSULTANTS

Practice address

18811 Enfield Ave N
Forest Lake, MN 55025-9489

Phone

(651) 485-4571

NPI assigned

Mar 24, 2011

Last updated

Mar 29, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kurt Edward Walstrom, MD

Title

Owner

Phone

(651) 485-4571

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1699074062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18811 ENFIELD AVE N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550259489",
            "telephone_number": "651-485-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18811 ENFIELD AVE N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550259489",
            "telephone_number": "651-485-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-24",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "WALSTROM",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-485-4571",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "47816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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.