Healthcare Provider Details

I. General information

NPI: 1215988894
Provider Name (Legal Business Name): DAKOTA CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N MAIN ST
MAHNOMEN MN
56557-4003
US

IV. Provider business mailing address

PO BOX 727
DETROIT LAKES MN
56502-0727
US

V. Phone/Fax

Practice location:
  • Phone: 218-936-5616
  • Fax: 218-936-5619
Mailing address:
  • Phone: 218-844-2300
  • Fax: 218-844-2444

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: LARRY G SOLBERG
Title or Position: ADMINISTRATOR-AUTHORIZED OFFICIAL
Credential:
Phone: 701-364-3405