Maxwell Ackerman
Individual provider Active NPI Specialist · Moorhead, MN
NPI 1497640221 · NPPES record last updated Jun 11, 2025
Key facts
- NPI
- 1497640221
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 1505 30TH Ave S
Moorhead, MN 56560-5149 - Phone
- (218) 287-4338
- NPI assigned
- Jun 11, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
1505 30TH Ave S
Moorhead, MN 56560-5149
Mailing address
1547 30TH Ave S
Moorhead, MN 56560-5149
Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.