Provider Demographics
NPI:1215960174
Name:MCLEOD-LORENCE, LAURIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANN
Last Name:MCLEOD-LORENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:13819 HANSON BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7608
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-862-4415
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260J0MCOtherBCBS OF MN
MN1691726OtherAMERICA'S PPO
MN1032342OtherPREFERRED ONE
MN142815OtherUCARE MN#
MN6605853OtherMEDICA UC #
MNHP35993OtherHEALTHPARTNERS
MN0109801OtherMEDICA #
MN7347461OtherAETNA INS
MN886498500Medicaid
MN142815OtherUCARE MN#
MNHP35993OtherHEALTHPARTNERS
MNH23709Medicare UPIN