John W Larsen, M.D.
Individual provider Active NPI Otology & Neurotology Physician · Waconia, MN
NPI 1497863401 · NPPES record last updated May 12, 2008
Key facts
- NPI
- 1497863401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otology & Neurotology Physician 207YX0901X
- License
- 20221 (MN)
- Practice address
- 490 S Maple St
Suite 205
Waconia, MN 55387-1760 - Phone
- (952) 925-5626
- Fax
- (952) 442-2180
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20221 | MN | MD | Otology & Neurotology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minnesota Otolaryngology, P.a. | Past |
Accepting new patients | |
| Carlson Chiropractic Health and Healing Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otology & Neurotology Physician | 207YX0901X | 20221 | MN | Yes |
Addresses
Primary practice location
490 S Maple St
Suite 205
Waconia, MN 55387-1760
Mailing address
490 S Maple St
Suite 205
Waconia, MN 55387-1760
Phone (952) 925-5626
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 489395600 | Medicaid | MN |
Other providers in Waconia, MN
- Ann Landreville
- Amanda Lane
- Samantha Jo Lanou
- Madeleine Victoria Larivella
- Mark R Larose
- Tamara Lynn Larsen
- Barrett Paul Larson II
- David Larson
- Jonathan M Larson
- Lisa Larson
All providers in Waconia, MN · Otology & Neurotology Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.