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General NPI Number Information
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NPI Number | 1871983478
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Entity Type | Organization
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Legal Business Name | DAKOTA MEDICAL CLINIC, PA
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 3408 DAKOTA AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2312
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Country | US
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Telephone | 952-924-1053
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Fax | 952-924-0254
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Provider Business Mailing Address
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Address Line | 3408 DAKOTA AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2312
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Country | US
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Telephone | 952-924-1053
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Fax | 952-924-0254
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DOLE
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Credential | M.D.
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Telephone | 952-924-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 29325
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License Number State | MN
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