Provider Demographics
NPI:1720493273
Name:SKEMP-DYMOND, GRACE (DO)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SKEMP-DYMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:SKEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S STE 5100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-6026
Mailing Address - Country:US
Mailing Address - Phone:952-832-0246
Mailing Address - Fax:
Practice Address - Street 1:7600 FRANCE AVE S STE 5100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-6026
Practice Address - Country:US
Practice Address - Phone:952-832-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11265660-1204207RR0500X
MN59571207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty