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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/Center

General Provider Information

NPI Number : 1770776890
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 : 952-888-7751
Fax Number :
Provider Business Practice Location Address
First Line : 7132 PORTLAND AVE
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-3264
Country : US
Telephone Number : 612-861-6160
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 : 10/09/2007

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Directions to “MARTIN LM LLC ” Practice Location

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