MEDICARE: DAKOTA CLINIC, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043261621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA CLINIC, LTD.

Provider Business Mailing Address
First Line	:	PO BOX 727
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56502-0727
Country	:	US
Telephone Number	:	218-844-2300
Fax Number	:	218-844-2444

Provider Business Practice Location Address
First Line	:	2049 2ND ST
Second Line	:
City	:	LAKE PARK
State	:	MN
Zip	:	56554-4000
Country	:	US
Telephone Number	:	218-238-5901
Fax Number	:	218-844-2444

Authorized Official
Title or Position	:	ADMINISTRATOR-AUTHORIZED OFFICIAL
Name	:	LARRY G SOLBERG
Credential	:
Telephone Number	:	701-364-3405

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/22/2020

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