Basic Information
| Provider Information | |||||||||
| NPI: | 1245320282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LASSI | ||||||||
| FirstName: | KIRAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11850 BLACKFOOT ST NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637122100 | ||||||||
| FaxNumber: | 7637122190 | ||||||||
| Practice Location | |||||||||
| Address1: | 11850 BLACKFOOT ST NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637122100 | ||||||||
| FaxNumber: | 7637122190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 23407 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | 53612 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | 53612 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.