Healthcare Provider Details

I. General information

NPI: 1215203898
Provider Name (Legal Business Name): SARTELL PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 2ND ST S
SARTELL MN
56377-1917
US

IV. Provider business mailing address

111 2ND ST S
SARTELL MN
56377-1917
US

V. Phone/Fax

Practice location:
  • Phone: 320-281-3339
  • Fax: 320-200-7505
Mailing address:
  • Phone: 320-281-3339
  • Fax: 320-200-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47571
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID LUCAS SMITH
Title or Position: OWNER
Credential: M.D.
Phone: 320-281-3339