Healthcare Provider Details

I. General information

NPI: 1245278936
Provider Name (Legal Business Name): THE DULUTH CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 E SUPERIOR ST
DULUTH MN
55804-2338
US

IV. Provider business mailing address

4621 E SUPERIOR ST
DULUTH MN
55804-2338
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3550
  • Fax:
Mailing address:
  • Phone: 218-786-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009