Provider Demographics
NPI:1417027822
Name:LAKIN, JAMES D (MD, PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:LAKIN
Suffix:
Gender:M
Credentials:MD, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2585
Mailing Address - Country:US
Mailing Address - Phone:952-223-3050
Mailing Address - Fax:
Practice Address - Street 1:350 W BURNSVILLE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2585
Practice Address - Country:US
Practice Address - Phone:952-223-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33295207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
030000213Medicare ID - Type Unspecified
C95153Medicare UPIN