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NPI Code Detail

MEDICARE: MR. ADAM GERRIT VAN DIJK MD

MEDICARE: MR. ADAM GERRIT VAN DIJK MD
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 Physician61226MN

General Provider Information

NPI Number : 1396091583
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADAM GERRIT VAN DIJK MD
Provider Business Mailing Address
First Line : 4209 WEBBER PKWY
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-1747
Country : US
Telephone Number : 763-581-5750
Fax Number : 763-581-5751
Provider Business Practice Location Address
First Line : 4209 WEBBER PKWY
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-1747
Country : US
Telephone Number : 763-581-5750
Fax Number : 763-581-5751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2012
Last Update Date : 01/04/2022

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