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General NPI Number Information
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NPI Number | 1144223009
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Entity Type | Organization
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Legal Business Name | TWIN CITIES DERMATOPATHOLOGY, LLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 9900 13TH AVENUE NORTH SUITE 2A
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City | PLYMOUTH
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State | MN
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Zip | 55441-5035
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Country | US
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Telephone | 763-525-0363
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Fax | 763-525-0369
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Provider Business Mailing Address
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Address Line | 9900 13TH AVENUE NORTH SUITE 2A
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City | PLYMOUTH
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State | MN
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Zip | 55441-5035
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Country | US
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Telephone | 763-525-0363
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Fax | 763-525-0369
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | LISA COOMBE
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Credential |
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Telephone | 763-525-0363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 1279
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License Number State | MN
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