MEDICARE: LINDSAY RAE EMMERICH PAC

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	207QA0505X	Adult Medicine Physician	12827	MN

General Provider Information

NPI Number	:	1205303070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY RAE EMMERICH PAC

Provider Business Mailing Address
First Line	:	7600 FRANCE AVE S STE 4100
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-6027
Country	:	US
Telephone Number	:	952-831-1551
Fax Number	:	952-831-0725

Provider Business Practice Location Address
First Line	:	7600 FRANCE AVE S STE 4100
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-6027
Country	:	US
Telephone Number	:	952-831-1551
Fax Number	:	952-831-0725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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