Southdale Physicians, LLC
Internal Medicine in Edina, MN. Organization (NPI-2).
NPI number1124569249
StatusActive
Last updated in NPPESFeb 17, 2025
Details
- NPI
- 1124569249
- Entity type
- Organization (NPI-2)
- Legal business name
- Southdale Physicians, LLC
- Organization subpart
- No
- Enumeration date
- Mar 9, 2017
- Certification date
- Feb 17, 2025
- Last updated
- Feb 17, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 207N00000X | Dermatology | – | – |
Practice location
6565 France Ave S Ste 350Edina, MN 55435-2137
Phone 612-430-8120
Mailing address
6565 France Ave S Ste 350Edina, MN 55435-2137
Authorized official
Derek J Dagendesh
Office Administrator
9529994049
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