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NPI Code Detail

MEDICARE: DAKOTA CLINIC, LTD.

MEDICARE: DAKOTA CLINIC, LTD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093767154
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAKOTA CLINIC, LTD.
Provider Business Mailing Address
First Line : PO BOX 6001
Second Line :
City : FARGO
State : ND
Zip : 58108-6001
Country : US
Telephone Number : 701-364-3300
Fax Number : 701-364-8906
Provider Business Practice Location Address
First Line : 1401 13TH AVE E
Second Line :
City : WEST FARGO
State : ND
Zip : 58078-3468
Country : US
Telephone Number : 701-364-5751
Fax Number : 701-364-5750
Authorized Official
Title or Position : ADMINISTRATOR-AUTHORIZED OFFICIAL
Name : LARRY G SOLBERG
Credential :
Telephone Number : 701-364-3405
Provider Enumeration Date : 05/17/2006
Last Update Date : 08/22/2020

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Directions to “DAKOTA CLINIC, LTD. ” Practice Location

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