Provider Demographics
NPI:1003833815
Name:LENNOX, SHELLEY M (MD)
Entity Type:Individual
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First Name:SHELLEY
Middle Name:M
Last Name:LENNOX
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Gender:F
Credentials:MD
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Mailing Address - Street 1:920 E 28TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1139
Mailing Address - Country:US
Mailing Address - Phone:612-863-9062
Mailing Address - Fax:612-863-9252
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-9062
Practice Address - Fax:612-863-9252
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-12-10
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Provider Licenses
StateLicense IDTaxonomies
MN38233207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2900012805OtherRAILROAD MEDICARE
MNG95379Medicare UPIN