Basic Information
| Provider Information | |||||||||
| NPI: | 1356397509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARKA | ||||||||
| FirstName: | EDMUND | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 ELM ST N | ||||||||
| Address2: | |||||||||
| City: | ONAMIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563597901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205323154 | ||||||||
| FaxNumber: | 3205323111 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 ELM ST N | ||||||||
| Address2: | |||||||||
| City: | ONAMIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563597901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205323154 | ||||||||
| FaxNumber: | 3205323111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 9595 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | NA9091027020 | 01 | MN | PREFERRED ONE | OTHER | HP32533 | 01 | MN | HEALTH PARTNERS | OTHER | 044927000 | 05 | MN | MEDICAID | 797S0LA | 01 | MN | BLUE CROSS CLINIC | OTHER | 01-17200 | 01 | MN | MEDICA ONAMIA | OTHER | 01-19647 | 01 | MN | MEDICA ISLE | OTHER | 151472 | 01 | MN | UCARE | OTHER | 504T0LA | 01 | MN | BLUE CROSS HOSPITAL | OTHER | 01-19649 | 01 | MN | MEDICA HILLMAN | OTHER | 410785161 | 01 | MN | TRICARE CHAMPUS | OTHER |