Provider Demographics
NPI:1881630051
Name:OKERLUND, LARRY BURTON (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:BURTON
Last Name:OKERLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:433 ELM ST N
Mailing Address - Street 2:CENTRACARE CLINIC - SAUK CENTRE
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378
Mailing Address - Country:US
Mailing Address - Phone:320-352-6591
Mailing Address - Fax:320-352-5164
Practice Address - Street 1:433 ELM ST N
Practice Address - Street 2:CENTRACARE CLINIC - SAUK CENTRE
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378
Practice Address - Country:US
Practice Address - Phone:320-352-6591
Practice Address - Fax:320-352-5164
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN26600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN557203700Medicaid
GA080075002OtherRAILROAD MEDICARE
MN5H099OKOtherBCBS
MNN003453OtherCHAMPUS
MN089004008Medicare ID - Type Unspecified
MND48859Medicare UPIN
GA080075002OtherRAILROAD MEDICARE