Provider Demographics
NPI:1588951719
Name:DOKMAK PSYCHIATRY PLLC
Entity type:Organization
Organization Name:DOKMAK PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOKMAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-303-4372
Mailing Address - Street 1:6750 FRANCE AVE S # 340
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1903
Mailing Address - Country:US
Mailing Address - Phone:952-303-4372
Mailing Address - Fax:952-303-4753
Practice Address - Street 1:6750 FRANCE AVE S # 340
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1903
Practice Address - Country:US
Practice Address - Phone:952-303-4372
Practice Address - Fax:952-303-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN453352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH85020Medicare UPIN