Basic Information
| Provider Information | |||||||||
| NPI: | 1912936329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKKERMAN | ||||||||
| FirstName: | DAVE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AKKERMAN | ||||||||
| OtherFirstName: | DAVID | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 3902 13TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581033357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013646600 | ||||||||
| FaxNumber: | 7013646628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 10/04/2011 | ||||||||
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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 | 207Q00000X | 5531 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 676540 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | ND100028 | 01 | ND | LHS # | OTHER | 79920AK | 01 | ND | MNBS # | OTHER | 79919AK | 01 | ND | MNBS # | OTHER | 0108610 | 01 | ND | MEDICA # | OTHER | 10363 | 01 | ND | NDBS # | OTHER | 221888700 | 05 | ND | MEDICAID | 0105959 | 01 | ND | MEDICA # | OTHER | 28726AK | 01 | ND | MNBS # | OTHER | 30Q41AK | 01 | ND | MNBS # | OTHER | DA9011015639 | 01 | ND | PREFERRED ONE # | OTHER | 141991 | 01 | ND | UCARE # | OTHER | HP19474 | 01 | ND | HEALTHPARTNERS # | OTHER | 0108129 | 01 | ND | MEDICA # | OTHER | 15741 | 05 | ND | MEDICAID | 8633 | 01 | ND | SIOUX VALLEY # | OTHER |