=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710033725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINNESOTA ALLERGY AND ASTHMA CONSULTANTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 04/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 E NICOLLET BLVD SUITE #250
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-223-3404
-----------------------------------------------------
Fax | 952-223-3041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 E NICOLLET BLVD SUITE #250
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-6741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-223-3404
-----------------------------------------------------
Fax | 952-223-3041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. JAMES D LAKIN
-----------------------------------------------------
Credential | PH.D., M.D.
-----------------------------------------------------
Telephone | 952-223-3404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------