Provider Demographics
NPI:1609828029
Name:ST. LUKE'S HOSPITAL OF DULUTH
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL OF DULUTH
Other - Org Name:MILLER CREEK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-249-5475
Mailing Address - Street 1:4190 LOBERG AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2652
Mailing Address - Country:US
Mailing Address - Phone:218-249-4600
Mailing Address - Fax:218-249-4666
Practice Address - Street 1:4190 LOBERG AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2652
Practice Address - Country:US
Practice Address - Phone:218-249-4600
Practice Address - Fax:218-249-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCD9674Medicare PIN
MNC06028Medicare PIN