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

Ethan M Dekam

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1033887385

Ethan M Dekam is a Physician Assistant in Burnsville, Minnesota. Qualified in 2023, 3 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth.

Years since qualifying
3
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

14000 Fairview Dr
Burnsville, MN 55337-5713
Phone: (952) 993-8700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1830 Greenhaven Ln Ne, Owatonna, MN 55060-2152 — (507) 676-6687

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1033887385
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 1, 2021
Last updated in NPPESOctober 20, 2023
Certification dateOctober 20, 2023
Mailing address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Burnsville