Provider Demographics
NPI:1699054361
Name:ADDICTION CARE PRACTITIONERS, PA
Entity type:Organization
Organization Name:ADDICTION CARE PRACTITIONERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRETAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-782-0900
Mailing Address - Street 1:17010 COUNTY ROAD 47
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-1124
Mailing Address - Country:US
Mailing Address - Phone:763-559-1110
Mailing Address - Fax:763-559-7668
Practice Address - Street 1:2904 JOHNSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2234
Practice Address - Country:US
Practice Address - Phone:612-782-0900
Practice Address - Fax:612-788-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22350207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty