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JOHN RICHARD LAKE MD NPI 1740360619


NPI Information

NPI: 1740360619
Provider Name: JOHN RICHARD LAKE, MD
Classification: Internal Medicine - 207RG0100X
Entity Type: Individual

Specialization: Gastroenterology

PECOS Registration: Yes

Address:
UNIVERSITY OF MINNESOTA PHYSICIANS
516 DELAWARE STREET SE, CLINIC 2A
MINNEAPOLIS, MN
ZIP 55454
Phone: (612) 626-6100
Get Directions

John Richard Lake, MD is a gastroenterology internal medicine in Minneapolis, MN with 45 years of experience. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. John Richard Lake, MD NPI is 1740360619. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Graduation Year:1979

The provider's business location address is:

UNIVERSITY OF MINNESOTA PHYSICIANS
516 DELAWARE STREET SE, CLINIC 2A
MINNEAPOLIS, MN
ZIP 55454-478
Phone: (612) 626-6100

The NPI 1740360619 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/16/2006 and was last updated on 10/26/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RG0100XInternal MedicineGastroenterology40739MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
103G121LAOTHERMINNESOTABCBS
2100000335MEDICARE ID-TYPE UNSPECIFIED
30506741MEDICAIDIOWA
4480019200MEDICAIDMINNESOTA
51017135OTHERMINNESOTAPREFERRED ONE
6114843OTHERMINNESOTAFAIRVIEW
7784417OTHERARAZ
829-00011OTHERMINNESOTAMEDICA-PRIMARY
92900020OTHERMINNESOTAMEDICA-CHOICE
100055301MEDICARE ID-TYPE UNSPECIFIEDMONTANAMT MA
11100011847MEDICARE ID-TYPE UNSPECIFIEDRAILROAD MEDICARE
12124409OTHERMINNESOTAUCARE
13HP28838OTHERMINNESOTAHEALTH PARTNERS
1432420100MEDICAIDWISCONSIN
15A49561MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.