=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538446059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALWA BAKKALI-DERKSEN DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2011
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 RAHNCLIFF CT STE 400
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55122-3470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-290-1209
-----------------------------------------------------
Fax | 833-973-3530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 113TH CT W
-----------------------------------------------------
City | FARIBAULT
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55021-7265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-321-3348
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 55057
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 57962
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------