MEDICARE: UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1033218599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

Provider Business Mailing Address
First Line	:	237 MEDICAL SCHOOL
Second Line	:	1035 UNIVERSITY DRIVE
City	:	DULUTH
State	:	MN
Zip	:	55812-3031
Country	:	US
Telephone Number	:	218-726-7386
Fax Number	:	218-726-7559

Provider Business Practice Location Address
First Line	:	1035 UNIVERSITY DR
Second Line	:	237 MEDICAL SCHOOL
City	:	DULUTH
State	:	MN
Zip	:	55812-3031
Country	:	US
Telephone Number	:	218-726-7386
Fax Number	:	218-726-7559

Authorized Official
Title or Position	:	DIRECTOR OF EXTERNAL SALES
Name	:	DR. LACRETIA BELL
Credential	:
Telephone Number	:	218-626-4473

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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Directions to “UNIVERSITY OF MINNESOTA MEDICAL SCHOOL ” Practice Location

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