Provider Demographics
NPI:1265022370
Name:NORTH STAR FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTH STAR FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LELCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-838-9913
Mailing Address - Street 1:4683 WILDERNESS COURT
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-382-2870
Mailing Address - Fax:
Practice Address - Street 1:4682 WILDERNESS CT STE 102
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2834
Practice Address - Country:US
Practice Address - Phone:218-382-2870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center