Provider Demographics
NPI:1215455217
Name:DAKOTA GASTROENTEROLOGY, LTD
Entity type:Organization
Organization Name:DAKOTA GASTROENTEROLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:FADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-365-1001
Mailing Address - Street 1:5049 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7080
Mailing Address - Country:US
Mailing Address - Phone:701-356-1001
Mailing Address - Fax:
Practice Address - Street 1:5049 33RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7080
Practice Address - Country:US
Practice Address - Phone:701-356-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAKOTA GASTROENTEROLOGY, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical