| Essentia Health Lakeside Clinic | |
|
4621 E Superior St Duluth MN 55804-2338 | |
| (218) 786-3550 | |
| Not Available |
| Full Name | Essentia Health Lakeside Clinic |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4621 E Superior St, Duluth, Minnesota |
| Authorized Official Name and Position | Kevin Boren (VP OF FINANCE) |
| Authorized Official Contact | 2187861009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Essentia Health Lakeside Clinic 4621 E Superior St Duluth MN 55804-2338 Ph: (218) 786-3550 | Essentia Health Lakeside Clinic 4621 E Superior St Duluth MN 55804-2338 Ph: (218) 786-3550 |
| NPI Number | 1245278936 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 02/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245278936 | NPI | - | NPPES |
| 1245278936 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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