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General NPI Number Information
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NPI Number | 1881962884
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Entity Type | Organization
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Legal Business Name | MINNESOTA ALLERGY & ASTHMA CLINIC, PA
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 350 W BURNSVILLE PKWY SUITE 200
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City | BURNSVILLE
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State | MN
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Zip | 55337-2585
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Country | US
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Telephone | 952-223-3040
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Fax | 952-223-3041
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Provider Business Mailing Address
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Address Line | 350 W BURNSVILLE PKWY SUITE 200
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City | BURNSVILLE
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State | MN
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Zip | 55337-2585
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Country | US
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Telephone | 952-223-3040
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Fax | 952-223-3041
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. JAMES D LAKIN
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Credential | MD
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Telephone | 952-223-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 33295
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License Number State | MN
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