Healthcare Provider Details

I. General information

NPI: 1386110005
Provider Name (Legal Business Name): DR. DANIEL BLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 12TH ST N STE 1000
SAINT CLOUD MN
56303-2255
US

IV. Provider business mailing address

1838 CHELSEA CT
IOWA CITY IA
52240-4762
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-7257
  • Fax: 320-251-2938
Mailing address:
  • Phone: 541-231-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number81528
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: