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SOUTH LAKE CLINIC P.A. NPI 1427027184


NPI Information

NPI: 1427027184
Provider Name: SOUTH LAKE CLINIC, P.A.

Doing Business As: SOUTH LAKE PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 24D2018597

Address:
17705 HUTCHINS DR
SUITE 101
MINNETONKA, MN
ZIP 55345
Phone: (952) 401-8300
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SOUTH LAKE CLINIC, P.A. is a pediatrics in Minnetonka, MN. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SOUTH LAKE CLINIC, P.A. NPI is 1427027184. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As South Lake Pediatrics.

The provider's business location address is:

17705 HUTCHINS DR
SUITE 101
MINNETONKA, MN
ZIP 55345-145
Phone: (952) 401-8300
Fax: (952) 401-8240

The provider's authorized official is Dale T Dobrin .
The authorized official title is Owner/medical Director and has the following contact phone number (952) 401-8300.

The CLIA number assigned to this NPI record is 24D2018597 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 3/15/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics556MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
116623SOOTHERMINNESOTABCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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