Healthcare Provider Details

I. General information

NPI: 1699855411
Provider Name (Legal Business Name): JUNE LAVALLEUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 24TH AVENUE SOUTH RIVERSIDE PROFESSIONAL BUILDING, SUITE 300
MINNEAPOLIS MN
55454
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 395 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7111
  • Fax:
Mailing address:
  • Phone: 612-273-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34622
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: