Provider Demographics
NPI:1881024271
Name:DAKOTA GASTROENTEROLOGY, LTD
Entity Type:Organization
Organization Name:DAKOTA GASTROENTEROLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-356-1001
Mailing Address - Street 1:5049 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7080
Mailing Address - Country:US
Mailing Address - Phone:701-356-1001
Mailing Address - Fax:701-639-4550
Practice Address - Street 1:5049 33RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7080
Practice Address - Country:US
Practice Address - Phone:701-356-1001
Practice Address - Fax:701-639-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty