Healthcare Provider Details

I. General information

NPI: 1386839041
Provider Name (Legal Business Name): MICHAEL J TEMPLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500-24TH AVE. S.W., SUITE 101 HEALTH CENTER-SOUTH RIDGE
MINOT ND
58701-6905
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-3778
  • Fax: 618-242-2551
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12189
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number12189
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: