Provider Demographics
NPI:1518179878
Name:JOHN E LACO DPM PA
Entity type:Organization
Organization Name:JOHN E LACO DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LACO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:952-435-3553
Mailing Address - Street 1:10651 165TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044
Mailing Address - Country:US
Mailing Address - Phone:952-435-3553
Mailing Address - Fax:952-241-3806
Practice Address - Street 1:10651 165TH STREET WEST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044
Practice Address - Country:US
Practice Address - Phone:952-435-3553
Practice Address - Fax:952-241-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-01-22
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
MN473725300Medicaid
MN59222LAOtherBCBS
MN1151960001Medicare NSC
MN59222LAOtherBCBS
MN473725300Medicaid