Provider Demographics
NPI:1598976326
Name:OAKDALE EAR, NOSE & THROAT CLINIC, P.A.
Entity Type:Organization
Organization Name:OAKDALE EAR, NOSE & THROAT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-233-5775
Mailing Address - Street 1:3366 OAKDALE AVE NORTH
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-233-5755
Mailing Address - Fax:763-233-5782
Practice Address - Street 1:3366 OAKDALE AVE NORTH
Practice Address - Street 2:SUITE 150
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-233-5755
Practice Address - Fax:763-233-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty