MEDICARE: LIFESCAN MINNESOTA LLC

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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396748307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESCAN MINNESOTA LLC

Provider Business Mailing Address
First Line	:	3955 PARKLAWN AVE
Second Line	:	STE 110
City	:	EDINA
State	:	MN
Zip	:	55435-5657
Country	:	US
Telephone Number	:	952-893-1997
Fax Number	:	952-893-0088

Provider Business Practice Location Address
First Line	:	3955 PARKLAWN AVE
Second Line	:	STE 110
City	:	EDINA
State	:	MN
Zip	:	55435-5657
Country	:	US
Telephone Number	:	952-893-1997
Fax Number	:	952-893-0088

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. MICHELLE DOUGLAS
Credential	:
Telephone Number	:	502-403-1401

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/12/2008

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Directions to “LIFESCAN MINNESOTA LLC ” Practice Location

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