# SOUTHDALE MEDICAL PARTNERS CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043898778
- **Authorized official:** MITCHELL PAUL BRANDT (ADMINISTRATOR)
- **Authorized official phone:** (612) 961-4322

## Contact information

- **Practice address:** 902 INWOOD AVE N STE 902, OAKDALE, MN 55128-6625
- **Practice address phone:** (952) 999-4049
- **Mailing address:** 902 INWOOD AVE N, SAINT PAUL, MN 55128-6625
- **Mailing address phone:** (651) 815-6880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2021
- **Last updated:** 05/03/2023