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General NPI Number Information
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NPI Number | 1063801116
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Entity Type | Organization
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Legal Business Name | ACACIA MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 1900 SUNRISE DR
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City | SAINT PETER
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State | MN
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Zip | 56082-5376
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Country | US
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Telephone | 507-931-2200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1993
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City | BURNSVILLE
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State | MN
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Zip | 55337-0995
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Country | US
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Telephone | 702-453-3799
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Fax | 702-453-5741
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Authorized Official
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Title or Position | ACCTS MANAGER
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Name | LORI LABRECQUE
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Credential |
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Telephone | 702-453-3799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 50217
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License Number State | MN
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