Healthcare Provider Details

I. General information

NPI: 1851370779
Provider Name (Legal Business Name): DAVID J ORCUTT 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 ST MANKATO CLINIC @ MAIN STREET
MANKATO MN
56002-8674
US

IV. Provider business mailing address

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 Code208600000X
TaxonomySurgery Physician
License Number44038
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number44038
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: