NPIMap

Organization Active NPI

Medicine Lake Consultation Group,PLLC

Doing business as lakes consultation group

  • Psychiatry Physician
  • St Louis Park, MN
National Provider Identifier
1881753564
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2084P0800X
Legal business name
MEDICINE LAKE CONSULTATION GROUP,PLLC
Doing business as
lakes consultation group
Practice address
1155 Ford Road
Unit B
St Louis Park, MN 55426
Phone
(952) 378-1800
Fax
(952) 378-1714
NPI assigned
Dec 8, 2006
Last updated
Jan 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Mrs. Ani C Ram
Title
Office Manager
Phone
(952) 378-1800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 103TC0700X MN
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 2084P0800X Primary

Addresses

Primary practice location

1155 Ford Road
Unit B
St Louis Park, MN 55426

Mailing address

1155 Ford Road
Unit B
St Louis Park, MN 55426
Phone (952) 378-1800

Other names 1

  • lakes consultation group Doing business as

National Provider Directory

National Provider Directory

Locations

1155 Ford Rd
Ste B
St Louis Park, MN 55426
Phone (952) 378-1800

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1881753564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 FORD ROAD",
            "address_2": "UNIT B",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "55426",
            "telephone_number": "952-378-1800",
            "fax_number": "952-378-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 FORD ROAD",
            "address_2": "UNIT B",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "55426",
            "telephone_number": "952-378-1800",
            "fax_number": "952-378-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE LAKE CONSULTATION GROUP,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "RAM",
        "authorized_official_first_name": "ANI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "952-378-1800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "103TC0700X",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": "2084P0800X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lakes consultation group",
            "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 Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.