Organization
SOUTH LAKE CLINIC, P.A.
Active
Other names
South Lake Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE T DOBRIN M.D. (OWNER/MEDICAL DIRECTOR)
(952) 401-8300
Entity
Organization
Contact information
Practice address
17705 HUTCHINS DR, SUITE 101, MINNETONKA, MN 55345-4145
(952) 401-8300
(952) 401-8243
Mailing address
17705 HUTCHINS DR, SUITE 101, MINNETONKA, MN 55345-4145
(952) 401-8300
(952) 401-8243
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
556
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091010400
—
MN
01
—
16623SO
BCBS
MN
Enumeration date
03/15/2006
Last updated
09/23/2024
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