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SOUTH LAKE PEDIATRICS
NPI 1770914095
Pediatrics in Maple Grove, MN

Active since December 12, 2013
12000 ELM CREEK BLVD N STE 250, MAPLE GROVE, MN 55369(952) 401-8300(952) 401-8243 Get Directions Write a Review

NPPES record last updated: August 29, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About South Lake Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH LAKE PEDIATRICS (NPI 1770914095) is a healthcare organization registered as a pediatrics in Maple Grove, Minnesota and active in the NPI registry since December 2013. The organization lists Heidi Northrup, Administrator, as its authorized official.

NPPES Registry Identity

NPI1770914095
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSOUTH LAKE CLINIC, PA
Location Address12000 ELM CREEK BLVD N STE 250Maple Grove, MN 55369-7164
Mailing Address17705 Hutchins Dr Ste 250Minnetonka, MN 55345-4103 · (952) 401-8300 · Fax (952) 401-8240
Phone(952) 401-8300
Fax(952) 401-8243
Organization SubpartNo
Authorized OfficialHeidi NorthrupAdministrator · (952) 401-8300
Enumeration DateDecember 12, 2013
Last NPPES UpdateAugust 29, 2023
NPPES CertifiedAugust 29, 2023
✔ NPI 1770914095 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
12000 ELM CREEK BLVD N STE 250, Maple Grove, MN 55369
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Other Names 1

Doing Business AsSouth Lake Pediatrics

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KARA ANN ENGEBRETSON LICSW
Social Worker (Clinical)
12000 ELM CREEK BLVD N STE 250
MAPLE GROVE, MN 55369
Hennepin County (952) 401-8300
MICHAEL BENJAMIN MAGALNICK D.O.
Pediatrics
12000 ELM CREEK BLVD N STE 250
MAPLE GROVE, MN 55369
Hennepin County (952) 401-8300
ELISABETH GILEAD
Nurse Practitioner (Pediatrics)
12000 ELM CREEK BLVD N STE 250
MAPLE GROVE, MN 55369
Hennepin County (952) 401-8300
ALYCIA R MIDAS MD
Pediatrics
12000 ELM CREEK BLVD N STE 250
MAPLE GROVE, MN 55369
Hennepin County (952) 401-8300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is South Lake Clinic, PA's NPI number?

The NPI number for South Lake Clinic, PA is 1770914095. It was assigned to this organization in the NPPES registry on December 12, 2013. The provider is doing business as South Lake Pediatrics.

Where is South Lake Clinic, PA located?

South Lake Clinic, PA is located at 12000 Elm Creek Blvd N Ste 250, Maple Grove, MN 55369. The listed phone number is (952) 401-8300.

What is South Lake Clinic, PA's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for South Lake Clinic, PA was last updated on August 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.