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General NPI Number Information
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NPI Number | 1588568505
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Entity Type | Organization
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Legal Business Name | LONGEVITY WEIGHT MANAGEMENT CLINIC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 16273 BAYWOOD LANE
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-4302
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Country | US
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Telephone | 612-327-2228
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Fax |
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Provider Business Mailing Address
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Address Line | 16526 W 78TH ST STE 188
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-4302
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Country | US
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Telephone | 612-327-2228
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NATALIE LOUISE IKEMAN
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Credential | PA-C
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Telephone | 612-327-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State | NULL
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