Healthcare Provider Details

I. General information

NPI: 1962516575
Provider Name (Legal Business Name): DAVID LEE GILBERTSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17645 JUNIPER PATH STE 155
LAKEVILLE MN
55044-7577
US

IV. Provider business mailing address

2315 COMO AVE
SAINT PAUL MN
55108-1723
US

V. Phone/Fax

Practice location:
  • Phone: 952-898-1022
  • Fax: 952-898-4006
Mailing address:
  • Phone: 651-646-2549
  • Fax: 651-646-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18265
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number18265
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: