Provider Demographics
NPI:1356397509
Name:LARKA, EDMUND ALEXANDER (PA)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:ALEXANDER
Last Name:LARKA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-7901
Mailing Address - Country:US
Mailing Address - Phone:320-532-3154
Mailing Address - Fax:320-532-3111
Practice Address - Street 1:200 ELM ST N
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-7901
Practice Address - Country:US
Practice Address - Phone:320-532-3154
Practice Address - Fax:320-532-3111
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9595363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA9091027020OtherPREFERRED ONE
MNHP32533OtherHEALTH PARTNERS
MN044927000Medicaid
MN797S0LAOtherBLUE CROSS CLINIC
MN01-17200OtherMEDICA ONAMIA
MN01-19647OtherMEDICA ISLE
MN151472OtherUCARE
MN504T0LAOtherBLUE CROSS HOSPITAL
MN01-19649OtherMEDICA HILLMAN
MN410785161OtherTRICARE CHAMPUS
MN970001874Medicare ID - Type UnspecifiedHILLMAN CLINIC
MN797S0LAOtherBLUE CROSS CLINIC
MN410785161OtherTRICARE CHAMPUS
MN970001872Medicare ID - Type UnspecifiedONAMIA CLINIC