Healthcare Provider Details

I. General information

NPI: 1417909557
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL OF DULUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OUTER DR
SILVER BAY MN
55614-1102
US

IV. Provider business mailing address

50 OUTER DR
SILVER BAY MN
55614-1102
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-4431
  • Fax:
Mailing address:
  • Phone: 218-249-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC LOHN
Title or Position: PRESIDENT, CEO
Credential:
Phone: 218-249-5475