Provider Demographics
NPI:1366569782
Name:ZENITH MEDICAL CLINIC
Entity type:Organization
Organization Name:ZENITH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LARBI-ODAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-503-1122
Mailing Address - Street 1:6800 78TH AVE N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2758
Mailing Address - Country:US
Mailing Address - Phone:763-503-1122
Mailing Address - Fax:763-503-1127
Practice Address - Street 1:6800 78TH AVE N
Practice Address - Street 2:SUITE 110
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2758
Practice Address - Country:US
Practice Address - Phone:763-503-1122
Practice Address - Fax:763-503-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1457311409OtherINDIVIDUAL NPI #
MNI26327Medicare UPIN