Individual
IAN J LALICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(612) 626-5900
(612) 884-0659
Mailing address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 672-7272
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
54175
MN
207YS0012X
Sleep Medicine (Otolaryngology) Physician
54175
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
06/14/2010
Last updated
02/02/2025
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