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

South Lake Clinic, PA

Organization Pediatrics Physician · NPI 1689005902

South Lake Clinic, PA is a Pediatrics Physician in Plymouth, Minnesota. Registered with an NPI since 2013.

In the registry since
2013
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

15535 34th Ave N Ste 100
Plymouth, MN 55447-2170
Phone: (952) 401-8300
Fax: (952) 401-8243
Show map & directions

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

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X

Record details

NPI number1689005902
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Heidi Northrup — Administrator · (952) 401-8300
Other names South Lake Pediatrics; South Lake Pediatrics
NPI enumeratedDecember 12, 2013
Last updated in NPPESSeptember 14, 2023
Certification dateSeptember 14, 2023
Mailing address17705 Hutchins Dr Ste 250, Minnetonka, MN 55345-4103

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