Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Avera St Luke's

Organization Plastic and Reconstructive Surgery Physician · NPI 1619273927

Avera St Luke's is a Plastic and Reconstructive Surgery Physician in Fargo, North Dakota. Licensed in South Dakota. Registered with an NPI since 2011.

Licensed in
SD
In the registry since
2011

Practice location Address checks out

4141 31st Ave S Ste 105
Fargo, ND 58104-8778
Phone: (605) 725-5030
Fax: (605) 725-5028
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X · Licence 10525 (SD)

Record details

NPI number1619273927
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ron Jacobson — Ceo · (605) 622-5125
Other names Cosmetics And Plastic Surgery
NPI enumeratedFebruary 3, 2011
Last updated in NPPESJune 30, 2011
Mailing addressPo Box 1460, Aberdeen, SD 57402-1460

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