Provider Demographics
NPI:1881962884
Name:MINNESOTA ALLERGY & ASTHMA CLINIC, PA
Entity type:Organization
Organization Name:MINNESOTA ALLERGY & ASTHMA CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-223-3040
Mailing Address - Street 1:350 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2585
Mailing Address - Country:US
Mailing Address - Phone:952-223-3040
Mailing Address - Fax:952-223-3041
Practice Address - Street 1:350 W BURNSVILLE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2585
Practice Address - Country:US
Practice Address - Phone:952-223-3040
Practice Address - Fax:952-223-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33295207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty