Provider Demographics
NPI:1821294554
Name:ESBERG, LUCY B (MD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:B
Last Name:ESBERG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 WAYZATA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2071
Mailing Address - Country:US
Mailing Address - Phone:952-232-6132
Mailing Address - Fax:952-600-8461
Practice Address - Street 1:1421 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2071
Practice Address - Country:US
Practice Address - Phone:952-232-6132
Practice Address - Fax:952-600-8461
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48843207RI0011X
CO2330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89280571Medicaid
CO318402YPNQMedicare PIN
COP01262148Medicare PIN