Unknown Individual – Pain Medicine (Anesthesiology) Physician, NPI 1679540785
Pain Medicine (Anesthesiology) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Hudson Boulevard, Lake Elmo, Washington County, Minnesota, 55042, United States
LAKE ELMO, MN 550428451
Phone: (651) 731-0707
Fax: (651) 739-1674
Type: Location
4928, Poppy Lane, Lake Edina, Edina, Hennepin County, Minnesota, 55435, United States
EDINA, MN 554354013
Phone: (952) 929-4117
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55042)
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