Organization
LIFESPARK MEDICAL GROUP, PA
Active
Organization
LIFESPARK MEDICAL GROUP, PA
Active
Parent organization
-
Other names
Lifespark Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
-
Authorized official
CATHERINE ANN LAURING (VICE PRESIDENT)
(952) 345-3213
Entity
Organization
Contact information
Practice address
5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
(952) 345-3310
(952) 345-8771
Mailing address
5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
(523) 453-3109
(952) 345-8771
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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