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General NPI Number Information
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NPI Number | 1518179878
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Entity Type | Organization
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Legal Business Name | JOHN E LACO DPM PA
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 10651 165TH STREET WEST
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City | LAKEVILLE
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State | MN
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Zip | 55044
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Country | US
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Telephone | 952-435-3553
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Fax | 952-241-3806
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Provider Business Mailing Address
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Address Line | 10651 165TH STREET WEST
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City | LAKEVILLE
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State | MN
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Zip | 55044
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Country | US
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Telephone | 952-435-3553
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Fax | 952-241-3806
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Authorized Official
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Title or Position | PODIATRIST
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Name | JOHN EDWARD LACO
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Credential | DPM
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Telephone | 952-435-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 420
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License Number State | MN
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