Organization
DULUTH KIDNEY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDY POPHAM MD (OWNER MD)
(218) 249-6230
Entity
Organization
Contact information
Practice address
925 E SUPERIOR ST, SUITE 106, DULUTH, MN 55802
(218) 249-6230
(218) 249-6231
Mailing address
925 E SUPERIOR ST, SUITE 106, DULUTH, MN 55802
(218) 249-6230
(218) 249-6231
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04N86PO
BLUE CROSS MN
MN
05
—
462137900
—
MN
01
—
9831014
MEDICA
—
Enumeration date
05/08/2006
Last updated
11/11/2008
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