Healthcare Provider Details

I. General information

NPI: 1053488452
Provider Name (Legal Business Name): ARNDT BEROEN BRAATEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 10TH AVE NE
DEER RIVER MN
56636-8703
US

IV. Provider business mailing address

ESSENTIA HEALTH DULUTH CLINIC - MCL2CRED 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-8275
  • Fax:
Mailing address:
  • Phone: 218-786-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45932
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number45932
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: