# LIFESPARK MEDICAL GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** -
- **Other names:** Lifespark Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437930278
- **Legal business name:** -
- **Authorized official:** CATHERINE ANN LAURING (VICE PRESIDENT)
- **Authorized official phone:** (952) 345-3213

## Contact information

- **Practice address:** 5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
- **Practice address phone:** (952) 345-3310
- **Practice address fax:** (952) 345-8771
- **Mailing address:** 5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
- **Mailing address phone:** (523) 453-3109
- **Mailing address fax:** (952) 345-8771

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | — |
| 207QA0505X | Adult Medicine Physician | — | — | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/09/2023
- **Last updated:** 10/09/2023