Provider Demographics
NPI:1184733545
Name:LYRENMANN, MICHAEL JAMES (OPA-C, RNFA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:LYRENMANN
Suffix:
Gender:M
Credentials:OPA-C, RNFA
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:7373 FRANCE AVE S
Practice Address - Street 2:SUITE 312
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4534
Practice Address - Country:US
Practice Address - Phone:952-832-0076
Practice Address - Fax:952-832-0477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR0831237364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
969991007207OtherPREFERREDONE
HP47971OtherHEALTHPARTNERS
55A74LYOtherBLUECROSS BLUESHIELD