Provider Demographics
NPI:1538446059
Name:BAKKALI-DERKSEN, SALWA (DO)
Entity type:Individual
Prefix:
First Name:SALWA
Middle Name:
Last Name:BAKKALI-DERKSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SALOUA
Other - Middle Name:
Other - Last Name:BAKKALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 113TH CT W
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-7265
Mailing Address - Country:US
Mailing Address - Phone:515-321-3348
Mailing Address - Fax:
Practice Address - Street 1:2000 RAHNCLIFF CT STE 400
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3470
Practice Address - Country:US
Practice Address - Phone:888-290-1209
Practice Address - Fax:833-973-3530
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55057208M00000X
MN57962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist