| Life Clinic Pllc | |
|
9220 Bass Lake Rd New Hope MN 55428-3000 | |
| (651) 237-3763 | |
| (651) 300-0992 |
| Full Name | Life Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 9220 Bass Lake Rd, New Hope, Minnesota |
| Authorized Official Name and Position | Isaac Adediran (PRESIDENT) |
| Authorized Official Contact | 6512373763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Clinic Pllc 9220 Bass Lake Rd New Hope MN 55428-3000 Ph: (651) 237-3763 | Life Clinic Pllc 9220 Bass Lake Rd New Hope MN 55428-3000 Ph: (651) 237-3763 |
| NPI Number | 1033927744 |
|---|---|
| Provider Enumeration Date | 12/27/2024 |
| Last Update Date | 12/27/2024 |
| Medicare PECOS PAC ID | 6305367376 |
|---|---|
| Medicare Enrollment ID | O20250306001088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033927744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Isaac Adediran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063826998 PECOS PAC ID: 3971880071 Enrollment ID: I20171120001770 |
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