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NPI Code Detail

MEDICARE: DR. MITCHELL J LACOMBE M.D.

MEDICARE: DR. MITCHELL J LACOMBE M.D.
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
1207Q00000XFamily Medicine Physician41195MN

General Provider Information

NPI Number : 1336144179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCHELL J LACOMBE M.D.
Provider Business Mailing Address
First Line : 5016 44TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1621
Country : US
Telephone Number : 612-721-9866
Fax Number : 612-721-2904
Provider Business Practice Location Address
First Line : 1315 E 24TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3975
Country : US
Telephone Number : 612-721-9866
Fax Number : 612-721-2904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 07/08/2007

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