Individual
DR. DENNIS DALE DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 DELAWARE STREET SE, PWB 1ST FL CLINIC 1A UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 626-6688
Mailing address
420 DELAWARE STREET SE, MMC 297 UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 625-2661
(612) 624-6686
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
26055
MN
208100000X
Physical Medicine & Rehabilitation Physician
Primary
26055
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075203700
—
MN
01
—
1009089
PREFERRED ONE
MN
01
—
101455
UCARE
MN
01
—
23-00008
MEDICA PRIMARY
MN
01
—
23-24496
MEDICA CHOICE
MN
01
—
2T420DY
BCBS
MN
01
—
609344
ARAZ
MN
01
—
HP22113
HEALTHPARTNERS
MN
Enumeration date
06/30/2006
Last updated
10/25/2012
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