Healthcare Provider Details

I. General information

NPI: 1275587974
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL OF DULUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E 2ND ST
DULUTH MN
55805-2200
US

IV. Provider business mailing address

1012 E 2ND ST
DULUTH MN
55805-2200
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-7910
  • Fax:
Mailing address:
  • Phone: 218-249-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC LOHN
Title or Position: PRESIDENT, CEO
Credential:
Phone: 218-249-5475