Integra Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

1944 Issued in MN

Legal business name

INTEGRA DERMATOLOGY PA

Practice address

7373 France Ave S Ste 510
Edina, MN 55435-4551

Phone

(612) 767-6000

NPI assigned

May 13, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Mimi Lam, MDNPI 1124184304

Title

Owner

Phone

(612) 767-6000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 4

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

• Mimi Lam, M.D.

  • Dermatology Physician
  • Savage, MN
  • NPI 1124184304
  Medicare reassignment Care Compare group NPD Authorized official
• Nora Elizabeth Burkart, MD

  • Surgery Physician
  • Edina, MN
  • NPI 1992969141
  Medicare reassignment Care Compare group NPD
• Angela Lynn Rohland, NP

  • Family Nurse Practitioner
  • Edina, MN
  • NPI 1417188608
  Medicare reassignment Care Compare group NPD
• Manuel A. Idrogo, M.D.

  • Family Medicine Physician
  • Saint Paul, MN
  • NPI 1588730675
  NPD (past)

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1366820136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S STE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354551",
            "telephone_number": "612-767-6000",
            "fax_number": "612-767-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S STE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354551",
            "telephone_number": "612-767-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRA DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "MIMI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-767-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MN",
            "license": "1944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN STATE LICENSE",
            "identifier": "1944",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Edina, MN
• Providers in Edina, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.