Organization
LAKE AREA DERMATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY FUCHS GANNON M.D. (PRESIDENT / OWNER)
(651) 224-4930
Entity
Organization
Contact information
Practice address
3640 TALMAGE CIR, SUITE 216, VADNAIS HEIGHTS, MN 55110-4183
(651) 224-4930
(651) 842-3391
Mailing address
2854 HIGHWAY 55, SUITE 130, EAGAN, MN 55121-1447
(651) 224-4930
(651) 842-3391
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
05/20/2011
Last updated
06/03/2011
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