Healthcare Provider Details

I. General information

NPI: 1164592770
Provider Name (Legal Business Name): NORTHLAND GASTROENTEROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 LONDON ROAD SUITE 202
DULUTH MN
55805
US

IV. Provider business mailing address

1420 LONDON ROAD SUITE 202
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-3411
  • Fax: 218-724-3408
Mailing address:
  • Phone: 218-724-3411
  • Fax: 218-724-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL PAUL MCKEE
Title or Position: PRESIDENT
Credential: MD
Phone: 218-724-3411