Healthcare Provider Details

I. General information

NPI: 1902872641
Provider Name (Legal Business Name): DAVID G DETERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 N HIGHWAY 20
CANNON FALLS MN
55009-1187
US

IV. Provider business mailing address

PO BOX 441 520 SOUTH SIBLEY AVE
LITCHFIELD MN
55355
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-3443
  • Fax: 507-529-6622
Mailing address:
  • Phone: 320-693-3233
  • Fax: 320-693-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23504
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: