Healthcare Provider Details

I. General information

NPI: 1962198317
Provider Name (Legal Business Name): ADAM ALEXANDER LORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PRAIRIE CENTER DR
EDEN PRAIRIE MN
55344-7301
US

IV. Provider business mailing address

830 PRAIRIE CENTER DR
EDEN PRAIRIE MN
55344-7301
US

V. Phone/Fax

Practice location:
  • Phone: 952-826-6500
  • Fax:
Mailing address:
  • Phone: 952-826-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81858
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: