Life Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LIFE CLINIC PLLC

Practice address

9220 Bass Lake Rd
New Hope, MN 55428-3000

Phone

(651) 237-3763

Fax

(651) 300-0992

NPI assigned

Dec 27, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Isaac Adediran, MDNPI 1063826998

Title

President

Phone

(651) 237-3763

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Isaac Adediran, M.D

  • Family Medicine Physician
  • Golden Valley, MN
  • NPI 1063826998
  Medicare reassignment NPD Authorized official
• Ingrid Christina Benyaminowich, LICSW

  • Clinical Social Worker
  • New Hope, MN
  • NPI 1790345742
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1033927744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9220 BASS LAKE RD",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283000",
            "telephone_number": "651-237-3763",
            "fax_number": "651-300-0992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 BASS LAKE RD",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283000",
            "telephone_number": "651-237-3763",
            "fax_number": "651-300-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-27",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "ADEDIRAN",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-237-3763",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tabby Lemlemu, MD
• Jaleesa Lenoir, MSW, LICSW
• Alea Kristine Lester, R.D., L.D.
• Life Health Care, Inc
• Mara Limbeck, MSW, LICSW
• Lineage Counseling
• Linkedin Home Health Care, LLC
• Jeffrey A Loch, RPH

• Family Medicine Physician in New Hope, MN
• Providers in New Hope, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.