Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 13424 | MN |
NPI | 1144651977 |
---|---|
Provider Name | Dennis Earl Lofstrom |
First Address | Kasson, MN 55944-1016 |
Second Address | Kasson, MN 55944-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 04/12/2013 |