MEDICARE: LAURIE S. AZINE D.O.

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	207R00000X	Internal Medicine Physician	45649	MN
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	45649	MN

General Provider Information

NPI Number	:	1376507491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE S. AZINE D.O.

Provider Business Mailing Address
First Line	:	3366 OAKDALE AVENUE NORTH
Second Line	:	SUITE 315, NORTH CLINIC, PA
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7989

Provider Business Practice Location Address
First Line	:	3366 OAKDALE AVENUE NORTH
Second Line	:	SUITE 315, NORTH CLINIC, PA
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2948
Country	:	US
Telephone Number	:	763-587-7900
Fax Number	:	763-587-7989

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	08/10/2010

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Directions to “ LAURIE S. AZINE D.O.” Practice Location

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