| NPI | 1124569249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK J DAGENDESH Office Administrator 952-999-4049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2025-02-17 |