Individual
MR. MAHMOOD AMELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC DACAN
Contact information
Practice address
16372 KENRICK AVENUE, SUITE 100 LAKEVILLE INTEGRATIVE MEDICINE CLINIC, LAKEVILLE, MN 55044
(952) 892-6700
(952) 892-9475
Mailing address
16372 KENRICK AVENUE, SUITE 100 LAKEVILLE INTEGRATIVE MEDICINE CLINIC, LAKEVILLE, MN 55044
(952) 892-6700
(952) 892-9475
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1237
MN
111NN0400X
Neurology Chiropractor
153
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127725100
—
MN
01
—
4401618
MEDICA PROVIDER NUMBER
MN
Enumeration date
06/07/2006
Last updated
05/15/2008
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