Provider Demographics
NPI:1649398546
Name:WOMEN'S HEALTH & LASER AESTHETIC CENTER, LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH & LASER AESTHETIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:KSHETTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-941-3188
Mailing Address - Street 1:7250 FRANCE AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4305
Mailing Address - Country:US
Mailing Address - Phone:952-831-2828
Mailing Address - Fax:952-831-2829
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-831-2828
Practice Address - Fax:952-831-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33696207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE60197Medicare UPIN