MEDICARE: DERMATOLOGY PROFESSIONALS, PA

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	261Q00000X	Clinic/Center	1699	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356714182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY PROFESSIONALS, PA

Provider Business Mailing Address
First Line	:	13359 ISLE DR
Second Line	:	SUITE 3
City	:	BAXTER
State	:	MN
Zip	:	56425-2222
Country	:	US
Telephone Number	:	218-454-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 24TH ST NW
Second Line	:	SUITE 110
City	:	BEMIDJI
State	:	MN
Zip	:	56601-6379
Country	:	US
Telephone Number	:	218-454-7546
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MORGAN BURGSTALER
Credential	:
Telephone Number	:	218-454-3065

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	06/12/2024

Similar Medicare Providers

1952266041 — HORN HEALTH PLLC
Practice Location Address:

2300 24TH ST NW STE 107
BEMIDJI, MN
56601-6379

Practice Phone: 218-358-1018
Practice Fax:

1780043240 — HEATHER M STONE MPT
Practice Location Address:

2300 24TH ST NW , SUITE 101
BEMIDJI, MN
56601-6379

Practice Phone: 218-444-2624
Practice Fax:

1801532544 — MR. AADIL AMIN RAJWANI MB BCH BAO
Practice Location Address:

1300 ANNE ST NW
BEMIDJI, MN
56601-5103

Practice Phone: 218-333-5000
Practice Fax:

1659710887 — JESSICA WILLIAMS APN
Practice Location Address:

1233 34TH ST NW
BEMIDJI, MN
56601-5112

Practice Phone: 218-333-5000
Practice Fax:

1750888475 — MELODY LYNN GORDEN MSW LICSW
Practice Location Address:

112 1ST ST W
BEMIDJI, MN
56601-4002

Practice Phone: 218-888-8032
Practice Fax: 218-888-8033

1427281583 — DEREK DAVID CZYWCZYNSKI O.D.
Practice Location Address:

2819 FOREST VIEW DR NE
BEMIDJI, MN
56601-9145

Practice Phone: 701-516-2115
Practice Fax:

Directions to “DERMATOLOGY PROFESSIONALS, PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.