Healthcare Provider Details

I. General information

NPI: 1114199635
Provider Name (Legal Business Name): MEDICAL ARTS PHYSICIANS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 DAKOTA AVE
WAHPETON ND
58075-4300
US

IV. Provider business mailing address

614 DAKOTA AVE
WAHPETON ND
58075-4300
US

V. Phone/Fax

Practice location:
  • Phone: 701-642-4471
  • Fax: 701-642-2878
Mailing address:
  • Phone: 701-642-4471
  • Fax: 701-642-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3751
License Number StateND

VIII. Authorized Official

Name: DEYON M SUCHLA
Title or Position: MEDICAL PRACTICE MANAGER
Credential:
Phone: 701-476-8414