Provider Demographics
NPI:1912936329
Name:AKKERMAN, DAVE S (MD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:S
Last Name:AKKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:S
Other - Last Name:AKKERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3902 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3357
Practice Address - Country:US
Practice Address - Phone:701-364-6600
Practice Address - Fax:701-364-6628
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND676540OtherAMERICA'S PPO/ARAZ #
NDND100028OtherLHS #
ND79920AKOtherMNBS #
ND79919AKOtherMNBS #
ND0108610OtherMEDICA #
ND10363OtherNDBS #
ND221888700Medicaid
ND0105959OtherMEDICA #
ND28726AKOtherMNBS #
ND30Q41AKOtherMNBS #
NDDA9011015639OtherPREFERRED ONE #
ND141991OtherUCARE #
NDHP19474OtherHEALTHPARTNERS #
ND0108129OtherMEDICA #
ND15741Medicaid
ND8633OtherSIOUX VALLEY #
ND141991OtherUCARE #
ND30Q41AKOtherMNBS #
ND080040388Medicare ID - Type UnspecifiedRR MEDICARE #