Organization
MEDICINE LAKE CONSULTATION GROUP,PLLC
Active
Other names
lakes consultation group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANI C RAM (OFFICE MANAGER)
(952) 378-1800
Entity
Organization
Contact information
Practice address
1155 FORD ROAD, UNIT B, ST LOUIS PARK, MN 55426
(952) 378-1800
(952) 378-1714
Mailing address
1155 FORD ROAD, UNIT B, ST LOUIS PARK, MN 55426
(952) 378-1800
(952) 378-1714
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
103TC0700X
MN
2084P0800X
Psychiatry Physician
Primary
2084P0800X
—
Other
Enumeration date
12/08/2006
Last updated
01/23/2015
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