SOUTH LAKE CLINIC, PA (NPI# 1780015008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780015008 |
| Entity Type | Organization |
| Organization Name | SOUTH LAKE CLINIC, PA |
| Other Organization Name | SOUTH LAKE PEDIATRICS |
| Practice Address |
17705 Hutchins Drive, Suite 250 Minnetonka MN 55345 |
| Mailing Address |
111 Hundertmark Road Suite 210 Chaska MN 55318 |
| Practice Telephone | 9524018300 |
| Practice Fax Number | 9524018243 |
| Mailing Telephone | 9524018300 |
| Mailing Fax Number | 9524018240 |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2013-12-12 |
| Authorized Official Name | HEIDI NORTHRUP (ADMINISTRATOR) |
| Authorized Official Telephone | 9524018300 |
| Authorized Official Credential | MHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| South Lake Pediatrics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770914095 | South Lake Clinic, Pa | Pediatrics | 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 | 2013-12-12 |
| 1043641368 | South Lake Clinic, Pa | Pediatrics | 17705 Hutchins Drive Suite, 250, Minnetonka, MN 55345 | 2013-12-12 |
| 1689005902 | South Lake Clinic, Pa | Pediatrics | 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 | 2013-12-12 |
| 1871924191 | South Lake Clinic, Pa | Pediatrics | 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 | 2013-12-12 |
| Street Address |
17705 HUTCHINS DRIVE, SUITE 250 |
| City | MINNETONKA |
| State | MN |
| Zip Code | 55345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417587205 | Pain Partners LLC | Pharmacist | 15225 Wild Wings Court, Minnetonka, MN 55345 | 2020-01-21 |
| 1356811608 | Caitlin Marie Peterson | Specialist/Technologist | 15708 Wood Knoll Lane, Minnetonka, MN 55345 | 2018-11-29 |
| 1649747007 | West Side Counseling LLC | Community/Behavioral Health | 10520 Wayzata Blvd., Suite 100, Minnetonka, MN 55345 | 2018-10-24 |
| 1689173247 | Theresa Tsuchiya | Psychologist | Relate, Inc., 5125 County Road 101, Suite 300, Minnetonka, MN 55345 | 2018-02-08 |
| 1497264147 | Minnetonka Assisted Living and Hospice | Community Health Worker | 14667 Lake Street Extension, Minnetonka, MN 55345 | 2017-09-26 |
| 1619494671 | Shree Revenue Management | Durable Medical Equipment & Medical Supplies | 6117, Creek Ridge Ct, Minnetonka, MN 55345 | 2017-08-29 |
| 1538606876 | Stefani Yanizeski | Speech-Language Pathologist | Minnesota Autism Center, 5710 Baker Road, Minnetonka, MN 55345 | 2017-01-25 |
| 1790157469 | Greg Anderson | Psychologist | 5125 County Road 101, #300, Relate, Inc., Minnetonka, MN 55345 | 2015-10-21 |
| 1861896375 | Kristine L Smith | Marriage & Family Therapist | 5125 County Road 101 Suite 300, Minnetonka, MN 55345 | 2014-10-13 |
| 1982014460 | Miranda Jean Johnson | Speech-Language Pathologist | 15265 Minnetonka Blvd., Minnetonka, MN 55345 | 2014-05-06 |
| Find all providers in zip 55345 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275144164 | Sundus Sabrie | Pediatrics | 17705 Hutchins Dr Ste 250, Minnetonka, MN 55345-4103 | 2020-08-13 |
| 1770914095 | South Lake Clinic, Pa | Pediatrics | 17705 Hutchins Drive Suite 250, Minnetonka, MN 55345 | 2013-12-12 |
| 1043641368 | South Lake Clinic, Pa | Pediatrics | 17705 Hutchins Drive Suite, 250, Minnetonka, MN 55345 | 2013-12-12 |
| 1235439548 | Crystal Singewald | Pediatrics | 17705 Hutchins Dr Ste 100, Minnetonka, MN 55345-4145 | 2010-11-02 |
| 1447480280 | Yana T. Nagle | Pediatrics | 17705 Hutchins Drive, Suite 101, South Lake Pediatrics, Minnetonka, MN 55345 | 2009-07-14 |
| 1417047879 | Daniel P Kohen | Pediatrics | 10505 Wayzata Blvd, Suite #200, Minnetonka, MN 55305-1502 | 2006-10-13 |
| 1063486595 | Burton Allan Benson Jr. | Pediatrics | 14001 Ridgedale Dr Ste 100, Minnetonka, MN 55305-1781 | 2006-02-13 |
| 1528030053 | Kelly Swearingen Lemieux | Pediatrics | 14001 Ridgedale Drive, #100, Minnetonka, MN 55305 | 2006-02-07 |
| 1942728936 | Shane Mcwhirter | Pediatrics | 14001 Ridgedale Dr Ste 100, Minnetonka, MN 55305-1781 | 2017-08-30 |
| 1972036531 | Jennifer Renee Signor | Pediatrics | 15111 Twelve Oaks Center Dr, Minnetonka, MN 55305-5202 | 2017-04-10 |
| Find all providers in MINNETONKA | ||||
| City | MINNETONKA |
| Zip Code | 55345 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.