Organization
SOUTHDALE PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK J DAGENDESH (OFFICE ADMINISTRATOR)
(952) 999-4049
Entity
Organization
Contact information
Practice address
6565 FRANCE AVE S STE 350, EDINA, MN 55435-2137
(612) 430-8120
Mailing address
6565 FRANCE AVE S STE 350, EDINA, MN 55435-2137
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/09/2017
Last updated
02/17/2025
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