MEDICARE: DR. CAROL LU MD

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	207R00000X	Internal Medicine Physician	45782	MN
2	208M00000X	Hospitalist Physician	45782	MN

General Provider Information

NPI Number	:	1902986698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL LU MD

Provider Business Mailing Address
First Line	:	7900 COBBLESTONE RD
Second Line	:	STE 100
City	:	WOODBURY
State	:	MN
Zip	:	55125-4328
Country	:	US
Telephone Number	:	651-338-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 KENNARD ST
Second Line	:	STE 100
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5465
Country	:	US
Telephone Number	:	651-232-7800
Fax Number	:	651-232-7940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	10/10/2017

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Directions to “ DR. CAROL LU MD” Practice Location

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