Unknown Individual – Family Medicine Physician, NPI 1417908880

Unknown Individual is a healthcare provider. based in Hibbing, Minnesota. specializing in Family Medicine Physician. They hold a License No. 21617 (MN). The NPI Number for Unknown Individual is 1417908880

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417908880
Phone
(218) 362-7100
Address
1120 E 34TH ST
Deactivation Date
5 December 2024

Doctor Profile

Medical School Name
UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Secondary Phone
2182497860
Graduation Year
1973 (53 years ago)
PAC ID
3274673207
Group Practice PAC ID
7113834839
Professional Enrollment ID
I20091222000519

Contacts

Secure Messaging
him@slk.direct.slhduluth.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 1120, East 34th Street, Hibbing, Saint Louis County, Minnesota, 55746, United States

    HIBBING, MN 557462909

    Phone: (218) 362-7100

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55746)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7113834839View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)MN
-MN
Vascular SurgeryIL
Physician AssistantMN
Emergency MedicineMN
-MN
Emergency MedicineMN
-MN
Physician AssistantMN
Hematology/Oncology, Internal MedicineMN

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1417908880 uniquely identifies Unknown Individual in U.S. healthcare data.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Hibbing, Minnesota. Check all listed addresses for suites or satellite offices.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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