Active NPI
Signe Dysken, M.D.
- Psychiatry Physician
- St Louis Park, MN
National Provider Identifier
1457437741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 28125
- Practice address
- 4500 Park Glen Rd
Suite 360
St Louis Park, MN 55416-4871 - Phone
- (612) 822-2111
- NPI assigned
- Oct 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 28125 | MN | Primary |
| Geriatric Psychiatry Physician | 2084P0805X | 28125 | MN |
Addresses
Primary practice location
4500 Park Glen Rd
Suite 360
St Louis Park, MN 55416-4871
Mailing address
4500 Park Glen Rd
Suite 360
St Louis Park, MN 55416-4871
Phone (612) 822-2111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28125 | MN | MD | Geriatric Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184457600000",
"number": "1457437741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 PARK GLEN RD",
"address_2": "SUITE 360",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554164871",
"telephone_number": "612-822-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 PARK GLEN RD",
"address_2": "SUITE 360",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554164871",
"telephone_number": "612-822-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYSKEN",
"first_name": "SIGNE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-28",
"last_updated": "2007-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "28125",
"primary": true
},
{
"code": "2084P0805X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Geriatric Psychiatry",
"state": "MN",
"license": "28125",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.