Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SOUTH LAKE CLINIC, PA
NPI 1770914095
Pediatrics in Maple Grove, MN

Q: 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.

Q: What is South Lake Clinic, PA's specialty?

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

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: September 28, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Sep 28, 2026, Aug 29, 2023 (2 updates tracked since 2023).

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About South Lake Clinic, Pa NPPES

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

SOUTH LAKE CLINIC, PA (NPI 1770914095), doing business as South Lake Pediatrics, is a healthcare organization registered as a pediatrics in Maple Grove, Minnesota and active in the NPI registry since December 2013. The organization lists Michael Garvis, Medical Director, 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 OfficialMichael GarvisMedical Director · (952) 401-8300

Enumeration DateDecember 12, 2013

Last NPPES UpdateSeptember 28, 20262 updates tracked since enumeration

NPPES CertifiedSeptember 28, 2026

✔ 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

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 September 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days 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.