Healthcare Provider Details

I. General information

NPI: 1841393378
Provider Name (Legal Business Name): DAVID G OPSAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 DREW AVE S
EDINA MN
55435-2103
US

IV. Provider business mailing address

6525 DREW AVE S
EDINA MN
55435-2103
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-6748
  • Fax: 952-920-3863
Mailing address:
  • Phone: 952-920-6748
  • Fax: 952-920-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20891
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: