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Organization
ACACIA MEDICAL GROUP PLLC
Active
Organization
ACACIA MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCTS MANAGER)
(702) 453-3799
Entity
Organization
Contact information
Practice address
1900 SUNRISE DR, SAINT PETER, MN 56082-5376
(507) 931-2200
Mailing address
PO BOX 1993, BURNSVILLE, MN 55337-0995
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
50217
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50217
MN LIC 50217
MN
Enumeration date
01/13/2015
Last updated
01/13/2015
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