Provider Demographics
NPI:1942256862
Name:DRILL-MELLUM, LAURIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:DRILL-MELLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-0081
Mailing Address - Country:US
Mailing Address - Phone:888-398-3327
Mailing Address - Fax:
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1752
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34306207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3F717DROtherBCBS
108039OtherUCARE
39-22638OtherMEDICA EMERG
1019590OtherPREFERRED ONE
HP13191OtherHEALTH PARTNERS
1019590OtherPREFERRED ONE
3F717DROtherBCBS
E82630Medicare UPIN