Basic Information
| Provider Information | |||||||||
| NPI: | 1699127605 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ORVEDAL | ||||||||
| FirstName: | DAKOTA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 W CENTRAL ENTRANCE # 160 | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558113433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187223700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557462341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187223700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | RL 14200 | ND | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 68689 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.