Provider Demographics
NPI:1376507491
Name:AZINE, LAURIE S (DO)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:AZINE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3366 OAKDALE AVENUE NORTH
Mailing Address - Street 2:SUITE 315, NORTH CLINIC, PA
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2948
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7989
Practice Address - Street 1:3366 OAKDALE AVENUE NORTH
Practice Address - Street 2:SUITE 315, NORTH CLINIC, PA
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7989
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN45649207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH99141Medicare UPIN