Organization · Type 2 NPI

South Lake Clinic, PA

Pediatrics Physician · Maple Grove, MN

NPI number 1770914095 Active

Practice location

12000 Elm Creek Blvd N Ste 250
Maple Grove, MN 55369-7164

Call (952) 401-8300 Map

Fax (952) 401-8243

Mailing address

17705 Hutchins Dr Ste 250
Minnetonka, MN 55345-4103

Specialties and licenses

TaxonomyCodeLicense
Pediatrics Physician Primary 208000000XNone listed

Pediatrics Physician: A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on de…

4 other providers at this address

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About NPI 1770914095

South Lake Clinic, PA's National Provider Identifier is 1770914095, issued on Dec 12, 2013. The primary taxonomy on file is Pediatrics Physician (208000000X), and the practice location is in Maple Grove, MN. The record was last updated on Sep 28, 2026.