Healthcare Provider Details

I. General information

NPI: 1003960006
Provider Name (Legal Business Name): ALLEN LESTER VANBEEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S SUITE 510
EDINA MN
55435-4534
US

IV. Provider business mailing address

7373 FRANCE AVE S SUITE 510
EDINA MN
55435-4534
US

V. Phone/Fax

Practice location:
  • Phone: 952-830-1028
  • Fax: 952-830-0091
Mailing address:
  • Phone: 952-830-1028
  • Fax: 952-830-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25914
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: