Healthcare Provider Details

I. General information

NPI: 1912691478
Provider Name (Legal Business Name): LILY SPENNEWYN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILY GROTHE MD

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 NW 26TH ST
OWATONNA MN
55060-5503
US

IV. Provider business mailing address

4600 36TH AVE S
MINNEAPOLIS MN
55406-3852
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-3850
  • Fax:
Mailing address:
  • Phone: 612-298-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: