Healthcare Provider Details

I. General information

NPI: 1891749594
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL OF DULUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 LOBERG AVE
HERMANTOWN MN
55811-2652
US

IV. Provider business mailing address

4190 LOBERG AVE
HERMANTOWN MN
55811-2652
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5700
  • Fax: 218-249-4666
Mailing address:
  • Phone: 218-249-5700
  • Fax: 218-249-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE BECKER
Title or Position: VP COMPLIANCE
Credential:
Phone: 218-249-5555