1750555314 NPI number — MIDWEST INSTITUTE OF UROLOGY

Table of content: DR. MITCHELL ARLEN LOMKE D.D.S. (NPI 1063430676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750555314 NPI number — MIDWEST INSTITUTE OF UROLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST INSTITUTE OF UROLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750555314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 FRANCE AVE S
Provider Second Line Business Mailing Address:
SUITE 660
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-922-2000
Provider Business Mailing Address Fax Number:
952-920-7739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE 660
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-922-2000
Provider Business Practice Location Address Fax Number:
952-920-7739
Provider Enumeration Date:
04/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUNDBLAD
Authorized Official First Name:
LYLE
Authorized Official Middle Name:
ERNEST
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
952-922-2000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35744 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)