Healthcare Provider Details

I. General information

NPI: 1326656737
Provider Name (Legal Business Name): LUKAS URBACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13911 RIDGEDALE DR STE 335
MINNETONKA MN
55305-1775
US

IV. Provider business mailing address

13911 RIDGEDALE DR STE 335
MINNETONKA MN
55305-1775
US

V. Phone/Fax

Practice location:
  • Phone: 612-875-6416
  • Fax:
Mailing address:
  • Phone: 612-875-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: