NPI 1366802290 · live from the CMS NPI Registry
Jeremiah Dagel, PA
Physician Assistant in Detroit Lakes, MN. National Provider Identifier 1366802290, active.
NPI record
| NPI | 1366802290 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 1027 Washington Ave, Detroit Lakes, MN 56501 |
| Practice phone | 218-847-5611 |
| Mailing address | Po Box 6001, Fargo, ND 58108 |
| Enumerated | March 4, 2016 |
| Last updated | April 1, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 2390 (MN) |
| Physician Assistant primary | 363A00000X | 12019 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.