Provider Demographics
NPI:1205870045
Name:LOBANOFF, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LOBANOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6099 WAYZATA BLVD STE 100-120
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5538
Mailing Address - Country:US
Mailing Address - Phone:952-204-5060
Mailing Address - Fax:952-204-9060
Practice Address - Street 1:6099 WAYZATA BLVD STE 100-120
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5538
Practice Address - Country:US
Practice Address - Phone:952-204-5060
Practice Address - Fax:952-204-9060
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN207W00000X207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH61350Medicare UPIN
MN1157570001Medicare NSC
MN1157570002Medicare NSC