Individual
MIKAELA CELINE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
101 MARTIN LUTHER KING JR DR, MANKATO, MN 56001
(507) 594-6500
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33509
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/04/2023
Last updated
05/25/2023
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