NPIMap

Organization Active NPI

Life Medical, P.a.

Doing business as Life Medical

  • Multi-Specialty Clinic/Center
  • St Louis Park, MN
National Provider Identifier
1740222496
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
LIFE MEDICAL, P.A.
Doing business as
Life Medical
Practice address
4201 Excelsior Blvd
Saint Louis Park, MN 55416-4728
Phone
(952) 933-1121
Fax
(952) 945-9536
NPI assigned
Jun 10, 2006
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Jacob I Mirman, MDNPI 1568404440
Title
Managing Partner
Phone
(952) 933-8900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X MN Primary

Addresses

Primary practice location

4201 Excelsior Blvd
Saint Louis Park, MN 55416-4728

Mailing address

4201 Excelsior Blvd
Saint Louis Park, MN 55416-4728
Phone (952) 933-8900

Other names 1

  • Life Medical Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@lifemedical.us Life Medical, P.A.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070221000166 MN Part B Supplier - Clinic/Group Practice 6204938350 Receives reassigned benefits from 16 practitioners
Practice locations: Edina, MN; Minneapolis, MN; Saint Louis Park, MN; Saint Paul, MN; St Louis Park, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1062275Life Medical, PA4201 Excelsior Blvd, Saint Louis Park, MN 55416Certificate of waiverDec 10, 2026

National Provider Directory

National Provider Directory

Locations

2700 E Lake St
Ste 3350
Minneapolis, MN 55406
Phone (612) 721-7771

2800 Joppa Ave S
St Louis Park, MN 55416
Phone (952) 564-3888

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1740222496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900",
            "fax_number": "952-945-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-1121",
            "fax_number": "952-945-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE MEDICAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "MIRMAN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "952-933-8900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@lifemedical.us",
            "affiliation": "Y",
            "affiliationName": "Life Medical, P.A.",
            "address_1": "4201 Excelsior Blvd",
            "city": "Saint Louis Park",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554164728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Life Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.