Healthcare Provider Details

I. General information

NPI: 1194700682
Provider Name (Legal Business Name): DAVID ROGER PLATTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JORDAN LN LONGVILLE LAKES CLINIC
LONGVILLE MN
56655-3164
US

IV. Provider business mailing address

180 JORDAN LN
LONGVILLE MN
56655-3164
US

V. Phone/Fax

Practice location:
  • Phone: 218-363-3300
  • Fax: 218-363-2233
Mailing address:
  • Phone: 218-363-3300
  • Fax: 218-363-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29951
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: