Healthcare Provider Details

I. General information

NPI: 1457508319
Provider Name (Legal Business Name): LAURENCE EDWARD WINTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SCHENDEL LAKE DR
LORETTO MN
55357-9590
US

IV. Provider business mailing address

8100 SCHENDEL LAKE DR
LORETTO MN
55357-9590
US

V. Phone/Fax

Practice location:
  • Phone: 763-498-7781
  • Fax:
Mailing address:
  • Phone: 763-498-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number18475
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: