Provider Demographics
NPI:1164592770
Name:NORTHLAND GASTROENTEROLOGY PA
Entity Type:Organization
Organization Name:NORTHLAND GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-724-3411
Mailing Address - Street 1:1420 LONDON ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805
Mailing Address - Country:US
Mailing Address - Phone:218-724-3411
Mailing Address - Fax:218-724-3408
Practice Address - Street 1:1420 LONDON ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-724-3411
Practice Address - Fax:218-724-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
83860OtherHEALTH PARTNERS
MNCJ5768OtherRAILROAD MEDICARE
MN065T6NOOtherBLUECROSS AND BLUESHIELD
MN065T6NOOtherBLUE SHIELD AND FIRST PLA
065T6NOOtherFIRST PLAN OF MINNESOTA
167970OtherUCARE
MN065T6NOOtherBLUE SHIELD AND FIRST PLA