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Organization
LIFESCAN MINNESOTA LLC
Active
Organization
LIFESCAN MINNESOTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE DOUGLAS (CREDENTIALING MANAGER)
(502) 403-1401
Entity
Organization
Contact information
Practice address
3955 PARKLAWN AVE, STE 110, EDINA, MN 55435-5657
(952) 893-1997
(952) 893-0088
Mailing address
3955 PARKLAWN AVE, STE 110, EDINA, MN 55435-5657
(952) 893-1997
(952) 893-0088
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9146652-00
—
MN
Enumeration date
05/23/2005
Last updated
06/12/2008
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