Lakes Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

51837 Issued in MN

Legal business name

LAKES DERMATOLOGY, PA

Practice address

14305 Southcross Dr W
Suite 110
Burnsville, MN 55306-7009

Phone

(612) 387-4627

Fax

(612) 377-9713

NPI assigned

Sep 23, 2015

Last updated

Sep 23, 2015By 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. Rehana Leila Ahmed-Saucedo, MD, PHDNPI 1427243898

Title

Dermatologist, President

Phone

(612) 387-4627

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 12

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.

• Rehana Leila Ahmed-Saucedo, M.D., PH.D.

  • Dermatology Physician
  • Burnsville, MN
  • NPI 1427243898
  Medicare reassignment Care Compare group Authorized official
• Nicole Gunasekera, MD, MBA

  • Dermatology Physician
  • Burnsville, MN
  • NPI 1457889909
  Medicare reassignment Care Compare group NPD
• Lydia An Luu, MD

  • MOHS-Micrographic Surgery Physician
  • Burnsville, MN
  • NPI 1285262170

  Dermatology

  Medicare reassignment Care Compare group NPD
• Erin Sellinger

  • Dermatology Physician
  • Plymouth, MN
  • NPI 1033537782
  Medicare reassignment Care Compare group NPD
• Kelly M Williams, M.D.

  • Dermatology Physician
  • Burnsville, MN
  • NPI 1679718415
  Medicare reassignment Care Compare group NPD
• Elizabeth N Boyum, PA

  • Physician Assistant
  • Burnsville, MN
  • NPI 1750320487
  Medicare reassignment Care Compare group
• Marisa A Chapman, M.D.

  • Dermatology Physician
  • Edina, MN
  • NPI 1932333697
  Medicare reassignment Care Compare group
• Kathryn Amelia Gehrig, MD

  • Dermatology Physician
  • Minnetonka, MN
  • NPI 1417121088
  Medicare reassignment Care Compare group
• Libby Slosburg Ratner, PA

  • Physician Assistant
  • Burnsville, MN
  • NPI 1952931792
  Medicare reassignment Care Compare group
• Elisabeth Hurliman, MD

  • Dermatology Physician
  • Waconia, MN
  • NPI 1730323304
  Medicare reassignment NPD
• Anna Marie Kozlowski, MD, MS

  • Dermatology Physician
  • St Louis Park, MN
  • NPI 1376040626
  Medicare reassignment NPD
• Nancy A Leitch, M.D.

  • Dermatology Physician
  • Minnetonka, MN
  • NPI 1437215613
  Medicare reassignment

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1962871608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 IRVING AVE S",
            "address_2": "SUITE 110",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554081049",
            "telephone_number": "612-387-4627",
            "fax_number": "612-377-9713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14305 SOUTHCROSS DR W",
            "address_2": "SUITE 110",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553067009",
            "telephone_number": "612-387-4627",
            "fax_number": "612-377-9713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "AHMED-SAUCEDO",
        "authorized_official_first_name": "REHANA",
        "authorized_official_middle_name": "LEILA",
        "authorized_official_title_or_position": "DERMATOLOGIST, PRESIDENT",
        "authorized_official_telephone_number": "612-387-4627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MN",
            "license": "51837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Jane Lagos
• Yeawah Bernadette Lucy Lahai
• Tiana Laino
• Catherine Lake
• Jennifer Lake
• James D Lakin, M.D., PH.D., M.B.A.
• Savannah Christine Lakose
• Lambo Therapy LLC
• Cynthia Fay Landis, MA CCC SLP
• Nicholas Edward Lange

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.