Healthcare Provider Details

I. General information

NPI: 1184973356
Provider Name (Legal Business Name): NORTHMARK MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 YANKEE DOODLE RD # 202
EAGAN MN
55121-2201
US

IV. Provider business mailing address

1260 YANKEE DOODLE RD # 202
EAGAN MN
55121-2201
US

V. Phone/Fax

Practice location:
  • Phone: 651-888-2613
  • Fax: 651-846-6777
Mailing address:
  • Phone: 651-888-2613
  • Fax: 651-846-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000828233
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number000828233
License Number State

VIII. Authorized Official

Name: D HAGLIND
Title or Position: OWNER
Credential:
Phone: 651-888-2613