Provider Information for 1194281824
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DIEUDONNE ACHUNCHE ASAMBANG LADC
Sex: Male
NPI: 1194281824
Last Updated: 2019-02-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1194281824 | ||||||||
| Enumeration Date | 2019-02-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9150 ZANZIBAR LN N APT 210 MAPLE GROVE, MN 55311-1674 United States Phone: 651-983-3003 | Fax: | ||||||||
| Primary Practice Address | 2301 CENTRAL AVE NE MINNEAPOLIS, MN 55418-3709 United States Phone: 612-588-9411 | Fax: | ||||||||
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