Basic Information
| Provider Information | |||||||||
| NPI: | 1861464398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHURLE | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | ROTH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHURLE | ||||||||
| OtherFirstName: | DALE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8600 NICOLLET AVE S | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554202824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525412800 | ||||||||
| FaxNumber: | 9528867015 | ||||||||
| Practice Location | |||||||||
| Address1: | 8600 NICOLLET AVE S | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554202824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525412800 | ||||||||
| FaxNumber: | 9528867015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 08/09/2013 | ||||||||
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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 | 207R00000X | 30518 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 440083600 | 05 | MN | MEDICAID |