Healthcare Provider Details

I. General information

NPI: 1184877599
Provider Name (Legal Business Name): DEREK THOMAS MAGAARD B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BROADWAY AVENUE NORTH FIVE COUNTY MENTAL HEALTH CENTER - BRAHAM OFFICE
BRAHAM MN
55006
US

IV. Provider business mailing address

521 BROADWAY AVENUE NORTH PO BOX 287
BRAHAM MN
55006
US

V. Phone/Fax

Practice location:
  • Phone: 320-396-3333
  • Fax: 320-396-3363
Mailing address:
  • Phone: 320-396-3333
  • Fax: 320-396-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: