Provider Demographics
NPI:1194922138
Name:JOHN E. LACO D.P.M., P.A.
Entity type:Organization
Organization Name:JOHN E. LACO D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LACO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:952-435-3553
Mailing Address - Street 1:10651 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5670
Mailing Address - Country:US
Mailing Address - Phone:952-435-3553
Mailing Address - Fax:952-241-3806
Practice Address - Street 1:1970 RAHNCLIFF CT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3404
Practice Address - Country:US
Practice Address - Phone:651-688-2505
Practice Address - Fax:952-241-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN420213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT01301Medicare UPIN