Dyste, Gregg N

Dyste, Gregg N is an individual health care provider with primary practice located at 11850 Blackfoot St Nw Suite 490, Coon Rapids MN 55433-2578. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Dyste, Gregg N can be contacted via phone (763) 427-1137.

Contact Information

Primary practice address
11850 Blackfoot St Nw Suite 490 Coon Rapids MN 55433-2578
Phone: (763) 427-1137
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 32612 Minnesota

Profile Details

NPI number 1649219171
LBN Legal business name Dyste, Gregg N
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Jul 20th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649219171 NPPES
Minnesota MEDICAID 910895500

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