Southdale Internal Medicine PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHDALE INTERNAL MEDICINE PA

Practice address

6545 France Avenue South
Suite 510
Edina, MN 55435

Phone

(952) 927-7079

Fax

(952) 920-9758

NPI assigned

Apr 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gary L Brunkow

Title

Physician Senior Partner

Phone

(952) 927-7079

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451260800000",
    "number": "1346207149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVENUE SOUTH",
            "address_2": "SUITE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-927-7079",
            "fax_number": "952-920-9758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVENUE SOUTH",
            "address_2": "SUITE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-927-7079",
            "fax_number": "952-920-9758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHDALE INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2015-12-28",
        "status": "A",
        "authorized_official_last_name": "BRUNKOW",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN SENIOR PARTNER",
        "authorized_official_telephone_number": "952-927-7079",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soundgate Hearing LLC
• Soundgate, Inc
• Maria Aglaia Soundia, DDS
• Southdale Anesthesiologists, LLC
• Southdale Dental Associates
• Southdale Optical Co
• Southdale Otolaryngology PA
• Southdale Pediatric Associates, LTD
• Southdale Periodontics
• Southdale Periodontics, PLLC

• All providers in Edina, MN
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.