Organization
DERMATOLOGY PROFESSIONALS, PA
Active
Organization
DERMATOLOGY PROFESSIONALS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MORGAN BURGSTALER (ADMINISTRATOR)
(218) 454-3065
Entity
Organization
Contact information
Practice address
2300 24TH ST NW, SUITE 110, BEMIDJI, MN 56601-6379
(218) 454-7546
Mailing address
13359 ISLE DR, SUITE 3, BAXTER, MN 56425-2222
(218) 454-7546
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1699
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
355427000
—
MN
Enumeration date
11/02/2015
Last updated
06/12/2024
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