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General NPI Number Information
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NPI Number | 1912641556
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Entity Type | Individual
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Provider Name | JACOB PATRICK LAMIRANDE
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Gender | Male
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 535 HOSPITAL RD
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1449
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Country | US
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Telephone | 715-243-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone | 952-541-2802
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 85766
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License Number State | WI
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