Healthcare Provider Details

I. General information

NPI: 1619118759
Provider Name (Legal Business Name): THE DULUTH CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 BEASER AVE
ASHLAND WI
54806-3604
US

IV. Provider business mailing address

1913 BEASER AVE
ASHLAND WI
54806-3604
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-4333
  • Fax:
Mailing address:
  • Phone: 715-682-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL C METCALF
Title or Position: EVP
Credential:
Phone: 218-786-2642