| Organization Name: | LIFESTYLE MEDICAL GROUP |
| NPI Number: | 1427465459 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MELISSA HANSON (OFFICE MANAGER) |
| Mailing Address: | 405 S Highway 44 76 Caledonia |
| State: | MN US |
| Postal Code: | 559211861 |
| Phone Number: | 5077258883 |
| Fax Number: | 6513051846 |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |