Provider Demographics
NPI:1891778155
Name:MINNERATH, DALE J (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:MINNERATH
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36914208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1001398OtherPREFERRED ONE
110412OtherU CARE
COMPOtherCHAMPUS
2114043OtherFIRST HEALTH PLAN
572105OtherARAZ GROUP AMERICAS PPO
1202203OtherMEDICA HEALTH PLANS
51A37MIOtherBLUE CROSS BLUE SHIELD
COMPOtherONE HEALTH PLAN GREAT WES
HP27103OtherHEALTH PARTNERS
COMPOtherMMSI
MN620027300OtherMEDIAL ASSISTANCE
1202203OtherMEDICA HEALTH PLANS
572105OtherARAZ GROUP AMERICAS PPO