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General NPI Number Information
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NPI Number | 1891937215
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Entity Type | Organization
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Legal Business Name | LUNDQUIST, PA
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S SUITE 480
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City | EDINA
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State | MN
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Zip | 55435-2131
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Country | US
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Telephone | 612-347-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 E BUSH LAKE RD SUITE 320
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City | MINNEAPOLIS
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State | MN
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Zip | 55439-3120
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Country | US
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Telephone | 952-831-5773
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Fax | 952-831-7224
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Authorized Official
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Title or Position | OWNER/MD
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Name | KIPTON LUNDQUIST
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Credential |
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Telephone | 612-347-3744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24005
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License Number State | MN
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