SOUTH LAKE CLINIC, PA


Address: 17705 Hutchins Drive, Suite 250, Minnetonka, MN 55345
Phone: 9524018300

SOUTH LAKE CLINIC, PA (NPI# 1780015008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780015008
Entity Type Organization
Organization Name SOUTH LAKE CLINIC, PA
Other Organization Name SOUTH LAKE PEDIATRICS
Practice Address 17705 Hutchins Drive, Suite 250
Minnetonka
MN 55345
Mailing Address 111 Hundertmark Road Suite 210
Chaska
MN 55318
Practice Telephone 9524018300
Practice Fax Number 9524018243
Mailing Telephone 9524018300
Mailing Fax Number 9524018240
Enumeration Date 2013-12-12
Last Update Date 2013-12-12
Authorized Official Name HEIDI NORTHRUP (ADMINISTRATOR)
Authorized Official Telephone 9524018300
Authorized Official Credential MHA
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208000000X Pediatrics Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
South Lake Pediatrics Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1770914095 South Lake Clinic, Pa Pediatrics 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 2013-12-12
1043641368 South Lake Clinic, Pa Pediatrics 17705 Hutchins Drive Suite, 250, Minnetonka, MN 55345 2013-12-12
1689005902 South Lake Clinic, Pa Pediatrics 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 2013-12-12
1871924191 South Lake Clinic, Pa Pediatrics 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 2013-12-12

Office Location

Street Address 17705 HUTCHINS DRIVE, SUITE 250
City MINNETONKA
State MN
Zip Code 55345

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1417587205 Pain Partners LLC Pharmacist 15225 Wild Wings Court, Minnetonka, MN 55345 2020-01-21
1356811608 Caitlin Marie Peterson Specialist/Technologist 15708 Wood Knoll Lane, Minnetonka, MN 55345 2018-11-29
1649747007 West Side Counseling LLC Community/Behavioral Health 10520 Wayzata Blvd., Suite 100, Minnetonka, MN 55345 2018-10-24
1689173247 Theresa Tsuchiya Psychologist Relate, Inc., 5125 County Road 101, Suite 300, Minnetonka, MN 55345 2018-02-08
1497264147 Minnetonka Assisted Living and Hospice Community Health Worker 14667 Lake Street Extension, Minnetonka, MN 55345 2017-09-26
1619494671 Shree Revenue Management Durable Medical Equipment & Medical Supplies 6117, Creek Ridge Ct, Minnetonka, MN 55345 2017-08-29
1538606876 Stefani Yanizeski Speech-Language Pathologist Minnesota Autism Center, 5710 Baker Road, Minnetonka, MN 55345 2017-01-25
1790157469 Greg Anderson Psychologist 5125 County Road 101, #300, Relate, Inc., Minnetonka, MN 55345 2015-10-21
1861896375 Kristine L Smith Marriage & Family Therapist 5125 County Road 101 Suite 300, Minnetonka, MN 55345 2014-10-13
1982014460 Miranda Jean Johnson Speech-Language Pathologist 15265 Minnetonka Blvd., Minnetonka, MN 55345 2014-05-06
Find all providers in zip 55345

Taxonomy Information

Taxonomy Code 208000000X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics

Taxonomy Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio
- Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1275144164 Sundus Sabrie Pediatrics 17705 Hutchins Dr Ste 250, Minnetonka, MN 55345-4103 2020-08-13
1770914095 South Lake Clinic, Pa Pediatrics 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 2013-12-12
1043641368 South Lake Clinic, Pa Pediatrics 17705 Hutchins Drive Suite, 250, Minnetonka, MN 55345 2013-12-12
1235439548 Crystal Singewald Pediatrics 17705 Hutchins Dr Ste 100, Minnetonka, MN 55345-4145 2010-11-02
1447480280 Yana T. Nagle Pediatrics 17705 Hutchins Drive, Suite 101, South Lake Pediatrics, Minnetonka, MN 55345 2009-07-14
1417047879 Daniel P Kohen Pediatrics 10505 Wayzata Blvd, Suite #200, Minnetonka, MN 55305-1502 2006-10-13
1063486595 Burton Allan Benson Jr. Pediatrics 14001 Ridgedale Dr Ste 100, Minnetonka, MN 55305-1781 2006-02-13
1528030053 Kelly Swearingen Lemieux Pediatrics 14001 Ridgedale Drive, #100, Minnetonka, MN 55305 2006-02-07
1942728936 Shane Mcwhirter Pediatrics 14001 Ridgedale Dr Ste 100, Minnetonka, MN 55305-1781 2017-08-30
1972036531 Jennifer Renee Signor Pediatrics 15111 Twelve Oaks Center Dr, Minnetonka, MN 55305-5202 2017-04-10
Find all providers in MINNETONKA

Competitor

Search similar providers

City MINNETONKA
Zip Code 55345

Improve Information

Please comment or provide details below to improve the information on SOUTH LAKE CLINIC, PA.

Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

Trending Searches