Provider Demographics
NPI:1205805850
Name:DENNIS, KARL M (PA-C)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:M
Last Name:DENNIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 86 SDS 12 2901
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-2901
Mailing Address - Country:US
Mailing Address - Phone:651-968-5050
Mailing Address - Fax:651-968-5900
Practice Address - Street 1:2090 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-968-5801
Practice Address - Fax:651-968-5899
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2009-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9979363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN221054100Medicaid
MN970002187Medicare ID - Type Unspecified
MN221054100Medicaid