Organization
LIFESTYLE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA HANSON (OFFICE MANAGER)
(507) 725-8883
Entity
Organization
Contact information
Practice address
405 S HIGHWAY 44 76, CALEDONIA, MN 55921-1861
(507) 725-8883
(651) 305-1846
Mailing address
405 S HIGHWAY 44 76, CALEDONIA, MN 55921-1861
(507) 725-8883
(651) 305-1846
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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