Gregg N Dyste, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

32612 Issued in MN

Practice address

11850 Blackfoot St NW
Suite 490
Coon Rapids, MN 55433-2578

Phone

(763) 427-1137

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437350400000",
    "number": "1649219171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11850 BLACKFOOT ST NW",
            "address_2": "SUITE 490",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332578",
            "telephone_number": "763-427-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11850 BLACKFOOT ST NW",
            "address_2": "SUITE 490",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332578",
            "telephone_number": "763-427-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYSTE",
        "first_name": "GREGG",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2015-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "32612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "910895500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Craig Dunham
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• Rachel M Dupaul, PHD, LP
• Ryan Justin Dusek, LADC
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• Specialist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.