Organization
ALLINA HEALTH SYSTEM
Active
Other names
Allina Health Forest Lake Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICA TALLARICO (COO)
(612) 222-2222
Entity
Organization
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
(651) 241-1515
Mailing address
2925 CHICAGO AVE, ROUTE 10202, MINNEAPOLIS, MN 55407-1321
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
01/27/2011
Last updated
03/21/2024
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