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General NPI Number Information
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NPI Number | 1033195656
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Entity Type | Individual
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Provider Name | DENNIS CHARLES SPANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 500 W GRANT ST
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City | LAKE CITY
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State | MN
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Zip | 55041-1143
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Country | US
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Telephone | 651-345-3321
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Fax | 651-345-1151
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Provider Business Mailing Address
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Address Line | 1200 GRANT BLVD W
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City | WABASHA
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State | MN
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Zip | 55981-1042
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Country | US
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Telephone | 651-565-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36426
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License Number State | MN
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