MEDICARE: LAKER BUILDERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1316742612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKER BUILDERS LLC

Provider Business Mailing Address
First Line	:	2501 SPRING LAKE RD SW
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-9508
Country	:	US
Telephone Number	:	612-812-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 SPRING LAKE RD SW
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-9508
Country	:	US
Telephone Number	:	612-812-6715
Fax Number	:

Authorized Official
Title or Position	:	PARTNER/DIRECTOR OF OPERATIONS
Name	:	CRISTOPHER MIEARS
Credential	:
Telephone Number	:	612-812-6715

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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Directions to “LAKER BUILDERS LLC ” Practice Location

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