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General NPI Number Information
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NPI Number | 1417251935
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Entity Type | Organization
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Legal Business Name | LTC PROFESSIONALS, PLLC
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 7801 EAST BUSH LAKE RD SUITE 400
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City | BLOOMINGTON
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State | MN
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Zip | 55439
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Country | US
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Telephone | 952-479-4261
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Fax | 866-991-7241
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Provider Business Mailing Address
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Address Line | 7801 EAST BUSH LAKE RD SUITE 400
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City | BLOOMINGTON
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State | MN
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Zip | 55439
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Country | US
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Telephone | 952-479-4261
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Fax | 866-991-7241
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KURT LARSON
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Credential |
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Telephone | 952-479-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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