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Contact Information

DEREK A MCLISTER, D.P.M
5225 23RD AVE S
FARGO, ND58104-7927
 Phone: 701-417-2575
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
 

Foot and Ankle Surgery

207XX0004X 02 Physician/General Surgery
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for DEREK A MCLISTER · (Male)

NPI Number 1114453552
Status Active
Credentials D.P.M
Entity Individual
Enumeration date 05/04/2017
Last updated 04/04/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 1068
  • ND License # 86
Hospital affiliation(s)
  • SANFORD MEDICAL CENTER FARGO - (Acute Care)
    801 BROADWAY NORTH
    FARGO, ND 58122
  • SANFORD MEDICAL CENTER THIEF RIVER FALLS - (Critical Access)
    120 LABREE AVENUE SOUTH
    THIEF RIVER FALLS, MN 56701
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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