Healthcare Provider Details

I. General information

NPI: 1235237538
Provider Name (Legal Business Name): LARRY C STUDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 NORTHDALE BLVD NW STE 220
COON RAPIDS MN
55433-3046
US

IV. Provider business mailing address

2104 NORTHDALE BLVD NW STE 220
COON RAPIDS MN
55433-3046
US

V. Phone/Fax

Practice location:
  • Phone: 763-537-6000
  • Fax: 763-537-6666
Mailing address:
  • Phone: 763-537-6000
  • Fax: 763-537-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37064
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number37064
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52383
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: