Healthcare Provider Details

I. General information

NPI: 1760446868
Provider Name (Legal Business Name): DAVID W LAPOSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JORDAN LANE
LONGVILLE MN
56655
US

IV. Provider business mailing address

320 EAST MAIN STREET
CROSBY MN
56441
US

V. Phone/Fax

Practice location:
  • Phone: 218-587-4416
  • Fax: 218-587-2677
Mailing address:
  • Phone: 218-546-7000
  • Fax: 218-546-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30274
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: