Healthcare Provider Details

I. General information

NPI: 1699758730
Provider Name (Legal Business Name): DANIEL C DEETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-9886
  • Fax: 608-392-7851
Mailing address:
  • Phone: 608-785-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34047
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number34047
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34047
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: