Healthcare Provider Details

I. General information

NPI: 1023078003
Provider Name (Legal Business Name): LAUREL B LADEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PINE ISLAND RD
MINNETONKA MN
55305-2420
US

IV. Provider business mailing address

2020 PINE ISLAND RD
MINNETONKA MN
55305-2420
US

V. Phone/Fax

Practice location:
  • Phone: 612-991-2983
  • Fax:
Mailing address:
  • Phone: 612-991-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30081
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: