| Life Medical, P.a. | |
|
4201 Excelsior Blvd Saint Louis Park MN 55416-4728 | |
| (952) 933-1121 | |
| (952) 945-9536 |
| Full Name | Life Medical, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4201 Excelsior Blvd, Saint Louis Park, Minnesota |
| Authorized Official Name and Position | Olga V Sheveleva (FINANCIAL CONTROLLER) |
| Authorized Official Contact | 9529331121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Medical, P.a. 4201 Excelsior Blvd Saint Louis Park MN 55416-4728 Ph: (952) 933-8900 | Life Medical, P.a. 4201 Excelsior Blvd Saint Louis Park MN 55416-4728 Ph: (952) 933-1121 |
| NPI Number | 1740222496 |
|---|---|
| Provider Enumeration Date | 06/10/2006 |
| Last Update Date | 11/30/2022 |
| Medicare PECOS PAC ID | 6204938350 |
|---|---|
| Medicare Enrollment ID | O20070221000166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740222496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Minnesota) | Primary |
| Provider Name | Lawrence W Biel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508818824 PECOS PAC ID: 6204810625 Enrollment ID: I20040615000207 |
| Provider Name | Bettejane K Goldman |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1528211836 PECOS PAC ID: 0042254427 Enrollment ID: I20050616000380 |
| Provider Name | Raisa Gringauz |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1396905212 PECOS PAC ID: 8224061742 Enrollment ID: I20050915000300 |
| Provider Name | Scott D Wagner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982648051 PECOS PAC ID: 0244332062 Enrollment ID: I20070226000509 |
| Provider Name | Jacob I Mirman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568404440 PECOS PAC ID: 9537263058 Enrollment ID: I20070322000334 |
| Provider Name | David J Freidson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821169129 PECOS PAC ID: 2961584370 Enrollment ID: I20080124000189 |
| Provider Name | Nina R Bacaner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578576021 PECOS PAC ID: 8628153889 Enrollment ID: I20080312000100 |
| Provider Name | Constantin Nicolaevich Starchook |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1942251822 PECOS PAC ID: 7810030673 Enrollment ID: I20100203000055 |
| Provider Name | Jack Lm Mutnick |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1487601316 PECOS PAC ID: 1658400866 Enrollment ID: I20100526001002 |
| Provider Name | Cole Anthony Buchtel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811281645 PECOS PAC ID: 4688938244 Enrollment ID: I20180507001447 |
| Provider Name | Sarah Anne Frid |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1538766324 PECOS PAC ID: 9133539497 Enrollment ID: I20201028000857 |
| Provider Name | Taran John Barrett |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1285205351 PECOS PAC ID: 7416353818 Enrollment ID: I20210910000318 |
| Provider Name | Jenni Mezeritski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447973201 PECOS PAC ID: 0840663225 Enrollment ID: I20230317000116 |
| Provider Name | Ker Xiong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548809890 PECOS PAC ID: 5597126292 Enrollment ID: I20230727002520 |
| Provider Name | Mai Ko Xiong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033986534 PECOS PAC ID: 1850744665 Enrollment ID: I20240129001833 |
| Provider Name | Akhsa Simonovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003599614 PECOS PAC ID: 0244675072 Enrollment ID: I20240301003056 |
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