| NPI | 1982065983 |
|---|---|
| Doing Business As | LAKE CLINIC |
| Entity Type | Organization |
| Authorized Contact | JACQUELYN LEE DENARDO Owner 952-210-7996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2025-06-05 |