Life Clinic Medical, PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1865 Issued in MN

Legal business name

LIFE CLINIC MEDICAL, PA

Practice address

5525 Cedar Lake Rd S
St Louis Park, MN 55416-1420

Phone

(866) 240-8437

Fax

(866) 240-9836

NPI assigned

Dec 28, 2012

Last updated

May 17, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kambiz Farbakhsh, M.D.

Title

Owner/ Founder

Phone

(866) 240-8437

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Courtney Cannon, PA

  • Physician Assistant
  • Minneapolis, MN
  • NPI 1487678124
  NPD (past)
• Thomas Klusmann

  • Physical Therapy Assistant
  • St Louis Park, MN
  • NPI 1669851986
  NPD (past)

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

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368748800000",
    "number": "1942546692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 CORPORATE PL",
            "address_2": "CORPORATE",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553174560",
            "telephone_number": "866-240-8437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 CEDAR LAKE RD S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161420",
            "telephone_number": "866-240-8437",
            "fax_number": "866-240-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC MEDICAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-28",
        "last_updated": "2013-05-17",
        "status": "A",
        "authorized_official_last_name": "FARBAKHSH",
        "authorized_official_first_name": "KAMBIZ",
        "authorized_official_title_or_position": "OWNER/ FOUNDER",
        "authorized_official_telephone_number": "866-240-8437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "1865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kay Elizabeth Lichtenberger, DPT
• Katie Marie Lick, R.D., L.D.
• Wayne D Liebhard, M.D.
• Jack L Liebo, M.D.
• Life and Light LLC
• Life Clinic, P.a.
• Life Medical, P.a. (Life Medical)
• Lifeclinic PA
• Lifeclinic Rehabilitation and Chiropractic
• Lifescan Minnesota Stand Up MRI LLC

• Internal Medicine Physician in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; 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.