Healthcare Provider Details

I. General information

NPI: 1639186752
Provider Name (Legal Business Name): ALICE KATHLEEN LINGEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 7TH ST NW
CASS LAKE MN
56633-3360
US

IV. Provider business mailing address

425 7TH ST NW
CASS LAKE MN
56633-3360
US

V. Phone/Fax

Practice location:
  • Phone: 218-335-3200
  • Fax: 218-335-3284
Mailing address:
  • Phone: 218-335-3200
  • Fax: 218-335-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166087-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: