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General NPI Number Information
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NPI Number | 1285596809
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Entity Type | Organization
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Legal Business Name | DAKOTA PEDIATRIC GASTROENTEROLOGY
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3284 51ST ST S UNIT 3
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City | FARGO
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State | ND
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Zip | 58104-7983
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Country | US
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Telephone | 701-532-2242
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Fax |
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Provider Business Mailing Address
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Address Line | 3419 BOHNET BLVD N
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City | FARGO
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State | ND
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Zip | 58102-1248
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Country | US
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Telephone | 701-532-2242
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY BLAUFUSS
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Credential | DO
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Telephone | 701-532-2242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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