Active NPI
Lakes Dermatology, PA
- Dermatology Physician
- Burnsville, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 51837
- 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
- Organization subpart
- No
NPPES NPI Registry
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, PHD
- Title
- Dermatologist, President
- Phone
- (612) 387-4627
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 51837 | MN | Primary |
Addresses
Primary practice location
14305 Southcross Dr W
Suite 110
Burnsville, MN 55306-7009
Mailing address
2732 Irving Ave S
Suite 110
Minneapolis, MN 55408-1049
Phone (612) 387-4627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151202002354 | MN | Part B Supplier - Clinic/Group Practice | 3375843089 |
Receives reassigned benefits from 12 practitioners Practice locations: St Louis Park, MN; Minnetonka, MN; Burnsville, MN |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2105418 | Lakes Dermatology | Compliance | Jul 19, 2026 |
National Provider Directory
National Provider DirectoryLocations
14305 Southcross Dr W
Ste 110
Burnsville, MN 55306
Phone (651) 304-1064
14001 Ridgedale Dr
Ste 300
Minnetonka, MN 55305
Phone (612) 387-4627
5353 Wayzata Blvd
Ste 505
St Louis Park, MN 55416
Phone (763) 316-4407
Practitioners & affiliated clinicians
Practitioners 12
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
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": []
}Other providers in Burnsville, MN
Sources for this page
- 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.