Dimitrov, Larissa M

Dimitrov, Larissa M is an individual health care provider with primary practice located at 4166 Lexington Ave N , Shoreview MN 55126-6106. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Dimitrov, Larissa M can be contacted via phone (651) 483-5461.

Contact Information

Primary practice address
4166 Lexington Ave N Shoreview MN 55126-6106
Phone: (651) 483-5461
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 72958 Minnesota
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 72958 Minnesota

Profile Details

NPI number 1386827053
LBN Legal business name Dimitrov, Larissa M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 17th, 2007
Last updated Sep 26th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1386827053 NPPES
Indiana Other 01062576A LICENSE

Popular Providers