Healthcare Provider Details

I. General information

NPI: 1417251935
Provider Name (Legal Business Name): LTC PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 07/25/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 EAST BUSH LAKE RD SUITE 400
BLOOMINGTON MN
55439
US

IV. Provider business mailing address

7801 EAST BUSH LAKE RD SUITE 400
BLOOMINGTON MN
55439
US

V. Phone/Fax

Practice location:
  • Phone: 952-479-4261
  • Fax: 866-991-7241
Mailing address:
  • Phone: 952-479-4261
  • Fax: 866-991-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KURT LARSON
Title or Position: PRESIDENT
Credential:
Phone: 952-479-4261