Individual
DR. LISA R. IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3910 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-4709
(952) 562-8787
(952) 562-8788
Mailing address
3910 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416-4709
(952) 562-8787
(952) 562-8788
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
41186
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
294718800
—
MN
Enumeration date
03/03/2006
Last updated
09/22/2011
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