Basic Information
| Provider Information | |||||||||
| NPI: | 1124078092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | HUGH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 WESTWOOD DR S | ||||||||
| Address2: | |||||||||
| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554163361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633773658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2545 CHICAGO AVE | ||||||||
| Address2: | SUITE 601 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128637770 | ||||||||
| FaxNumber: | 6128637772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 21578 | MN | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 37T88DU | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 527875900 | 05 | MN | MEDICAID | 30843300 | 01 | MN | WISCONSIN MA | OTHER | 122058D417 | 01 | MN | UCARE | OTHER | 1700085 | 01 | MN | MEDICA | OTHER | HP13201 | 01 | MN | HEALTHPARTNERS | OTHER |