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General NPI Number Information
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NPI Number | 1881653772
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Entity Type | Individual
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Provider Name | LUCIANO I KOLODNY MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 12910 12TH ST N
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City | LAKE ELMO
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State | MN
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Zip | 55042-8602
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Country | US
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Telephone | 612-616-4939
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Fax |
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Provider Business Mailing Address
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Address Line | 12910 12TH ST N
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City | LAKE ELMO
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State | MN
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Zip | 55042-8602
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Country | US
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Telephone | 612-616-4939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 43176-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036-103933
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 45441
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License Number State | MN
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