Provider Demographics
NPI:1861479461
Name:AUGDAHL, LON J (MD)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:J
Last Name:AUGDAHL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8455 FLYING CLOUD DR
Practice Address - Street 2:STE 200
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3974
Practice Address - Country:US
Practice Address - Phone:952-993-7400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN415622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH02938Medicare UPIN