Basic Information
| Provider Information | |||||||||
| NPI: | 1184652414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLECKMAN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 08/26/2011 | ||||||||
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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 | 207RR0500X | 4923 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 29183 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 3200072 | 01 | ND | MEDICA # | OTHER | 14356 | 05 | ND | MEDICAID | 54828SL | 01 | MN | MNBS # | OTHER | ND200061 | 01 | ND | LHS # | OTHER | 3200086 | 01 | ND | MEDICA # | OTHER | 48617SL | 01 | MN | MNBS # | OTHER | 911594 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 6430 | 01 | MN | NDBS # | OTHER | DA9011015589 | 01 | ND | PREFERRED ONE # | OTHER | 06335SL | 01 | ND | MNBS # | OTHER | 91643SL | 01 | ND | MNBS # | OTHER | 10016 | 01 | MN | NDBS # | OTHER | 1285 | 01 | ND | NDBS # | OTHER | 2284 | 01 | ND | NDBS # | OTHER | 79889SL | 01 | ND | MNBS # | OTHER |