Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Child and Teen Medical Center

Organization Pediatrics Physician · NPI 1225158520

Child and Teen Medical Center is a Pediatrics Physician in Blaine, Minnesota. Works from 2 locations. Registered with an NPI since 2007.

In the registry since
2007
Specialties on file
2
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Practice location Address checks out

11107 Ulysses St NE Ste 100
Blaine, MN 55434-4184
Phone: (763) 333-7733
Fax: (763) 333-7711
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7225 University Ave Ne, Fridley, MN 55432-3134 — (763) 333-7733

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X
Medical Specialty Clinic/Center Taxonomy 261QM2500X

Record details

NPI number1225158520
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Angela Bennett — Practic Administrator · (763) 333-7755
Other names Fridley Children'S And Teenagers' Medical Center Pa
NPI enumeratedMarch 30, 2007
Last updated in NPPESAugust 24, 2021
Certification dateAugust 24, 2021
Mailing address11107 Ulysses St Ne Ste 100, Blaine, MN 55434-4184

Other providers in Blaine