| NPI | 1871924191 |
|---|---|
| Doing Business As | SOUTH LAKE PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | HEIDI NORTHRUP Administrator 952-401-8300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2023-08-29 |