Individual
DR. LARRY STEVEN SIDAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3000 32ND AVENUE SOUTH, ESSENTIA HEALTH 32ND AVENUE CLINIC, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
400 EAST THIRD STREET, ESSENTIA HEALTH DULUTH CLINIC MCL2CRED, DULUTH, MN 55805-1951
(218) 786-1183
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
6614
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005335
SD BCBS
SD
05
—
0501643
—
IA
01
—
36047SI
MN BCBS - PLAN 91057NO
MN
01
—
36623
HEALTH PARTNERS
—
05
—
41986380
—
MN
01
—
4303
DAKOTACARE
SD
05
—
6003420
—
SD
01
—
931451029047
PREFERRED ONE
—
Enumeration date
05/23/2006
Last updated
07/21/2022
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