Provider Demographics
NPI:1891766804
Name:VAN OPPEN, DIRK J (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:J
Last Name:VAN OPPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 LIST PL
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4559
Mailing Address - Country:US
Mailing Address - Phone:612-924-9433
Mailing Address - Fax:
Practice Address - Street 1:1965 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1923
Practice Address - Country:US
Practice Address - Phone:651-698-2406
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17443207V00000X
SD4538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6201170Medicaid
SD6201172Medicaid
SD6201172Medicaid
SDBV6349092OtherDEA
SD100659Medicare ID - Type Unspecified
MNAV3647661OtherDEA