Healthcare Provider Details

I. General information

NPI: 1770654279
Provider Name (Legal Business Name): KAREN BENEDICTE LARSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 COUNTY ROAD D W MEDTOX LABORATORIES, INC.
SAINT PAUL MN
55112-3522
US

IV. Provider business mailing address

402 COUNTY ROAD D W MEDTOX LABORATORIES, INC.
SAINT PAUL MN
55112-3522
US

V. Phone/Fax

Practice location:
  • Phone: 651-628-6115
  • Fax:
Mailing address:
  • Phone: 651-628-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number46238
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: