DR. LARRY STEVEN SIDAWAY


Address: 3000 32nd Avenue South, Essentia Health 32nd Avenue Clinic, Fargo, ND 58103-6132
Phone: 7013648000

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
6614 ND Allopathic & Osteopathic Physicians

Other Provider Identifier

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

Office Location

Street Address 3000 32ND AVENUE SOUTH
ESSENTIA HEALTH 32ND AVENUE CLINIC
City FARGO
State ND
Zip Code 58103-6132

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 207RC0000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Cardiovascular Disease

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City FARGO
Zip Code 58103

Improve Information

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Dataset Information

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.

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