=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417949520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHLAND FAMILY PHYSICIANS, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2005
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 E 1ST ST SUITE 108
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805-2297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-723-1100
-----------------------------------------------------
Fax | 218-723-4062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 E 1ST ST SUITE 108
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805-2297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-723-1100
-----------------------------------------------------
Fax | 218-723-4062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | CINDY ERLEMEIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-723-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------