Healthcare Provider Details

I. General information

NPI: 1275569477
Provider Name (Legal Business Name): NORTHLAND PLASTIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 RICE LAKE RD STE 109
DULUTH MN
55811-2885
US

IV. Provider business mailing address

4316 RICE LAKE RD STE 109
DULUTH MN
55811-2885
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-7363
  • Fax: 218-724-6199
Mailing address:
  • Phone: 218-724-7363
  • Fax: 218-724-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN WEBER
Title or Position: PRESIDENT
Credential: MD
Phone: 218-724-7363