Healthcare Provider Details

I. General information

NPI: 1164874574
Provider Name (Legal Business Name): DANIEL HANSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2016
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18432 KENRICK AVE
LAKEVILLE MN
55044
US

IV. Provider business mailing address

18432 KENRICK AVE
LAKEVILLE MN
55044-9288
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-8800
  • Fax:
Mailing address:
  • Phone: 952-993-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-10701
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65984
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: