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NPI Code Detail

MEDICARE: MARTIN LM LLC

MEDICARE: MARTIN LM 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
1261QA0600XAdult Day Care Clinic/CenterMN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689867707
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARTIN LM LLC
Provider Business Mailing Address
First Line : 1401 E 100TH ST
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2615
Country : US
Telephone Number : 952-948-5154
Fax Number :
Provider Business Practice Location Address
First Line : 1401 E 100TH ST
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-2615
Country : US
Telephone Number : 952-948-5154
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DENVER KAUFMAN
Credential :
Telephone Number : 612-371-0053
Provider Enumeration Date : 08/22/2007
Last Update Date : 12/17/2008

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Directions to “MARTIN LM LLC ” Practice Location

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