Organization
CENTRAL LAKES MEDICAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D PETERSON (CEO)
(218) 546-2501
Entity
Organization
Contact information
Practice address
318 EAST MAIN STREET, CROSBY, MN 56441-1691
(218) 546-8375
(218) 546-4400
Mailing address
318 EAST MAIN STREET, CROSBY, MN 56441-1691
(218) 546-8375
(218) 546-4400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1160
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088208900
—
MN
Enumeration date
06/27/2006
Last updated
10/09/2008
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