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General NPI Number Information
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NPI Number | 1215990791
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Entity Type | Organization
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Legal Business Name | NORTHLAND FAMILY PHYSICIANS LLC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2650 32ND AVE S STE D
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City | GRAND FORKS
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State | ND
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Zip | 58201-6541
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Country | US
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Telephone | 701-732-2700
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Fax | 701-732-2701
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Provider Business Mailing Address
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Address Line | PO BOX 5210
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City | GRAND FORKS
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State | ND
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Zip | 58206-5210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK G PETERSON
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Credential | MD
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Telephone | 701-732-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | ND
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