Healthcare Provider Details

I. General information

NPI: 1538254289
Provider Name (Legal Business Name): ENDOCRINE & DIABETES ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

710 E.24TH ST. SUITE 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: DR. LAWRENCE MULMED
Title or Position: PRESIDENT
Credential: MD FACE
Phone: 612-336-5000