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Organization
ALLINA HEALTH SYSTEM
Active
Organization
ALLINA HEALTH SYSTEM
Active
Other names
Allina Health Forest Lake Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICA TALLARICO (COO)
(612) 222-2222
Entity
Organization
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
(651) 241-1515
Mailing address
2925 CHICAGO AVE, ROUTE 10202, MINNEAPOLIS, MN 55407-1321
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
01/27/2011
Last updated
03/21/2024
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