Organization
DULUTH GRADUATE MEDICAL EDUCATION COUNCIL INC
Active
Other names
Duluth Family Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHAILENDRA PRASAD MD (BOARD CHAIR)
(612) 624-7629
Entity
Organization
Contact information
Practice address
330 N 8TH AVE E, DULUTH, MN 55805-2024
(218) 723-1112
(218) 529-9120
Mailing address
330 N 8TH AVE E, DULUTH, MN 55805-2024
(218) 723-1112
(218) 529-9120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32674900
—
WI
05
—
647010600
—
MN
01
—
69226FA
BCBSMN
MN
Enumeration date
11/16/2005
Last updated
05/24/2023
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