Provider Demographics
NPI:1508846619
Name:NORTHERN PINES ORTHOPAEDIC CLINIC, P.A.
Entity Type:Organization
Organization Name:NORTHERN PINES ORTHOPAEDIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-326-8749
Mailing Address - Street 1:111 GOLF COURSE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3526
Mailing Address - Country:US
Mailing Address - Phone:218-326-8749
Mailing Address - Fax:218-326-0400
Practice Address - Street 1:111 GOLF COURSE RD
Practice Address - Street 2:STE 1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3526
Practice Address - Country:US
Practice Address - Phone:218-326-8749
Practice Address - Fax:218-326-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty