Healthcare Provider Details

I. General information

NPI: 1437569282
Provider Name (Legal Business Name): TODD PLOCHER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 GRAND AVE
DULUTH MN
55807-2737
US

IV. Provider business mailing address

4212 GRAND AVE
DULUTH MN
55807-2737
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3500
  • Fax:
Mailing address:
  • Phone: 218-786-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: