Organization · NPI-2

Illumia Health LLC

Internal Medicine, Hospice and Palliative Medicine · White Bear Lake, MN

NPI number1972316289
StatusActive
Last updated in NPPESMay 16, 2025

Details

NPI
1972316289
Entity type
Organization (NPI-2)
Legal business name
Illumia Health LLC
Organization subpart
No
Enumeration date
Jan 30, 2025
Certification date
May 16, 2025
Last updated
May 16, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RH0002X Internal Medicine, Hospice and Palliative Medicine––Yes

Practice location

3580 Linden Ave Ste A1
White Bear Lake, MN 55110-4625

Phone 704-664-2876 · Fax 704-230-0946

Mailing address

Po Box 4060
Attn: Regulatory
Mooresville, NC 28117-4060

Phone 704-664-2876

Other practice locations

350 S 5th St
Minneapolis, MN 55415-1316

Phone 704-664-2876 · Fax 704-230-0946

Authorized official

Janet L. Combs
Vp Of Licensure
7046621761

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