DR. LARRY STEVEN SIDAWAY (NPI# 1841245743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1841245743 |
Entity Type | Individual |
Full Name | DR. LARRY STEVEN SIDAWAY |
Credential | DO |
Practice Address |
3000 32nd Avenue South Essentia Health 32nd Avenue Clinic Fargo ND 58103-6132 |
Mailing Address |
400 East Third Street Essentia Health Duluth Clinic Mcl2cred Duluth MN 55805-1951 |
Practice Telephone | 7013648000 |
Mailing Telephone | (218) 786-1183 |
Enumeration Date | 2006-05-23 |
Last Update Date | 2017-09-06 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
6614 | ND | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
PREFERRED ONE | 931451029047 | 01 | |
SD | SD BCBS | 0005335 | 01 |
SD | 6003420 | 05 | |
IA | 0501643 | 05 | |
MN | MN BCBS - PLAN 91057NO | 36047SI | 01 |
HEALTH PARTNERS | 36623 | 01 | |
SD | DAKOTACARE | 4303 | 01 |
MN | 41986380 | 05 |
Street Address |
3000 32ND AVENUE SOUTH ESSENTIA HEALTH 32ND AVENUE CLINIC |
City | FARGO |
State | ND |
Zip Code | 58103-6132 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912359431 | Nikolai Tolkachev | Hospitalist | 3000 32nd Avenue South, Fargo, ND 58103 | 2016-07-08 |
1083053995 | Kristina K Rauser-foltz | Pediatrics | 3000 32nd Avenue South, Fargo, ND 58103 | 2013-06-24 |
1992728752 | Thomas R Magill | Emergency Medicine | 3000 32nd Avenue South, Fargo, ND 58103-6132 | 2006-07-25 |
1659393734 | Sarah J. Mccullough | Emergency Medicine | 3000 32nd Avenue South, Fargo, ND 58103-6132 | 2006-07-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
Find all providers in zip 58103 |
Taxonomy Code | 207RC0000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Cardiovascular Disease |
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841550357 | Oludamilola Wuraola Oluleye | Internal Medicine | 3000 32nd Ave South, Fargo, ND 58103 | 2012-05-18 |
1497872675 | Jaise Thekkan Poulose | Internal Medicine | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2007-03-23 |
1861575573 | Ralph Enrique Morales | Internal Medicine | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2006-10-24 |
1376565960 | Joshua Wynne | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-24 |
1134140353 | Wallace E Radtke | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-22 |
1063430619 | Jonathan L Dickson | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1871511436 | Craig R Kouba | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1932127537 | Christopher L Pierce | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1063430791 | David J Clardy | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1437176906 | Manuel R Otero-cagide | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-17 |
Find all providers in FARGO |
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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.