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NPI Code Detail

MEDICARE: DR. PATRICK THOMAS DORNACK M.D.

MEDICARE: DR. PATRICK THOMAS DORNACK M.D.
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 Physician54089MN

General Provider Information

NPI Number : 1477797264
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK THOMAS DORNACK M.D.
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2555 COUNTY ROAD E E
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-4906
Country : US
Telephone Number : 651-241-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2009
Last Update Date : 11/28/2012

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