Healthcare Provider Details

I. General information

NPI: 1821077819
Provider Name (Legal Business Name): DONALD C PUTZIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 E MAIN STREET MANKATO CLINIC @ MAIN STREET
MANKATO MN
56002-8674
US

IV. Provider business mailing address

1230 E MAIN ST PO BOX 8674 MANKATO CLINIC LTD
MANKATO MN
56002-8674
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-1811
  • Fax:
Mailing address:
  • Phone: 507-625-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35305
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier938332
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1723107
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerAMERICAS PPO
# 3
Identifier41084933956001C079
Identifier TypeOTHER
Identifier State
Identifier IssuerCHAMPUS
# 4
Identifier1202177
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMEDICA
# 5
Identifier579800100
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 6
IdentifierNA2951023854
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerPREFERRED ONE
# 7
Identifier112219
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerUCARE
# 8
Identifier370005416
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE
# 9
Identifier1M362PU
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBCBS
# 10
IdentifierHP25963
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerHEALTH PARTNERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: