Organization
INTEGRA DERMATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIMI LAM MD (OWNER)
(612) 767-6000
Entity
Organization
Contact information
Practice address
7373 FRANCE AVE S STE 510, EDINA, MN 55435-4551
(612) 767-6000
Mailing address
7373 FRANCE AVE S STE 510, EDINA, MN 55435-4551
(612) 767-6000
(612) 767-6600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1944
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1944
MN STATE LICENSE
MN
Enumeration date
05/13/2015
Last updated
06/22/2021
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