Healthcare Provider Details

I. General information

NPI: 1760861496
Provider Name (Legal Business Name): DAKOTA PEDIATRICS PROVIDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 CARMEN AVE
INVER GROVE HEIGHTS MN
55076-4416
US

IV. Provider business mailing address

5975 CARMEN AVE
INVER GROVE HEIGHTS MN
55076-4416
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-9697
  • Fax: 651-455-2012
Mailing address:
  • Phone: 651-455-9697
  • Fax: 651-455-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DEE
Title or Position: COO
Credential:
Phone: 651-604-8962