| Organization Name: | SOUTH LAKE CLINIC, PA |
| NPI Number: | 1043641368 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HEIDI NORTHRUP (ADMINSTRATOR) |
| Mailing Address: | 17705 Hutchins Drive Suite, 250 Minnetonka |
| State: | MN US |
| Postal Code: | 55345 |
| Phone Number: | 9524018300 |
| Fax Number: | 9524018243 |
| NPI Enumeration Date: | 12/12/2013 |
| NPI Last Update Date: | 12/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | |
| Taxonomy 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. |