Healthcare Provider Details

I. General information

NPI: 1245226562
Provider Name (Legal Business Name): LAWRENCE NEIL MULMED MD FACE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 24TH ST STE 405
MINNEAPOLIS MN
55404-3840
US

IV. Provider business mailing address

710 E 24TH ST STE 405
MINNEAPOLIS MN
55404-3840
US

V. Phone/Fax

Practice location:
  • Phone: 612-336-5000
  • Fax: 612-775-9800
Mailing address:
  • Phone: 612-336-5000
  • Fax: 612-775-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number20522
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: