Healthcare Provider Details

I. General information

NPI: 1578564092
Provider Name (Legal Business Name): DAVID JOSEPH NEESE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 117TH LN NW
COON RAPIDS MN
55433-2666
US

IV. Provider business mailing address

3790 117TH LN NW
COON RAPIDS MN
55433-2666
US

V. Phone/Fax

Practice location:
  • Phone: 763-421-7300
  • Fax: 763-421-3337
Mailing address:
  • Phone: 763-421-7300
  • Fax: 763-421-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number475
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: