South Lake Clinic, PA

NPI #1780015008 in Chaska, Minnesota

Provider Information

NPI Number: 1780015008
Entity Type: Organization
Organization Name: South Lake Clinic, PA
Primary Specialty: Pediatrics
Enumeration Date: Dec 12, 2013
Last Updated: Aug 29, 2023

Practice Location

Address: 111 HUNDERTMARK RD STE 210
City: Chaska
State: Minnesota
ZIP Code: 55318-1196
Phone: (952) 401-8300

Authorized Official

Name: HEIDI NORTHRUP, MHA
Title: ADMINISTRATOR
Phone: (952) 401-8300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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