Provider Demographics
NPI:1205303070
Name:EMMERICH, LINDSAY RAE (PAC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RAE
Last Name:EMMERICH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:BARTKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S STE 4100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-6027
Mailing Address - Country:US
Mailing Address - Phone:952-831-1551
Mailing Address - Fax:952-831-0725
Practice Address - Street 1:7600 FRANCE AVE S STE 4100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-6027
Practice Address - Country:US
Practice Address - Phone:952-831-1551
Practice Address - Fax:952-831-0725
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12827207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine