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Organization
CEDAR LAKE COMMUNITY CLINIC PA
Active
Organization
CEDAR LAKE COMMUNITY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTEN L COULTER M.D. (PRESIDENT / MEDICAL DIRECTOR)
(612) 276-1000
Entity
Organization
Contact information
Practice address
1831 E LAKE ST, MINNEAPOLIS, MN 55407-1809
(612) 276-1000
(612) 729-1885
Mailing address
1831 E LAKE ST, MINNEAPOLIS, MN 55407-1809
(612) 276-1000
(612) 729-1885
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
07/07/2010
Last updated
02/01/2011
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