Healthcare Provider Details

I. General information

NPI: 1235668229
Provider Name (Legal Business Name): DAKOTA TYLER THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-1722
  • Fax: 612-624-4545
Mailing address:
  • Phone: 319-356-2902
  • Fax: 319-356-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number76875
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: