NPI 1881753564

Medicine Lake Consultation Group,pllc

Organisation Psychiatry Physician St Louis Park, MN

Practice location

Address: 1155 Ford Road Unit B, St Louis Park, MN 55426
Phone: (952) 378-1800
Fax: (952) 378-1714

Authorised official

Name: Ani C Ram
Title: Office Manager
Phone: (952) 378-1800

Registered specialties (2)

Psychiatry Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2084P0800X Licence 2084P0800X

Other Psychiatry & Neurology providers in Minnesota →

Clinical Psychologist

Behavioral Health & Social Service Providers Taxonomy 103TC0700X Licence 103TC0700X (MN)

Other Psychologist providers in Minnesota →

Registry record

NPI: 1881753564
Entity type: Organization
NPI issued: 8 Dec 2006
Record last updated: 23 Jan 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.