| Spark Medical Providers Pa | |
|
5320 W 23rd St Ste 130 St Louis Park MN 55416-1670 | |
| (952) 345-8770 | |
| Not Available |
| Full Name | Spark Medical Providers Pa |
|---|---|
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 5320 W 23rd St Ste 130, St Louis Park, Minnesota |
| Authorized Official Name and Position | Catherine Ann Lauring (CEO) |
| Authorized Official Contact | 9523458770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spark Medical Providers Pa 5320 W 23rd St Ste 130 St Louis Park MN 55416-1670 Ph: (952) 345-8770 | Spark Medical Providers Pa 5320 W 23rd St Ste 130 St Louis Park MN 55416-1670 Ph: (952) 345-8770 |
| NPI Number | 1760374680 |
|---|---|
| Provider Enumeration Date | 07/16/2025 |
| Last Update Date | 07/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760374680 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
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