Irvin, Lisa R.

Irvin, Lisa R. is an individual health care provider with primary practice located at 3910 Excelsior Blvd , St Louis Park MN 55416-4709. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Irvin, Lisa R. can be contacted via phone (952) 562-8787.

Contact Information

Primary practice address
3910 Excelsior Blvd St Louis Park MN 55416-4709
Phone: (952) 562-8787
Fax: (952) 562-8788
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 41186 Minnesota

Profile Details

NPI number 1124095575
LBN Legal business name Irvin, Lisa R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 3rd, 2006
Last updated Sep 22nd, 2011 - about 13 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124095575 NPPES
Minnesota MEDICAID 294718800

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