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NPI Code Detail

MEDICARE: DENNIS CHARLES SPANO M.D.

MEDICARE:   DENNIS CHARLES SPANO  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician36426MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4080125255OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
149A86SPOTHERBCBS
2118169OTHERUCARE
3MH9101008904OTHERPREFERRED ONE
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
60113159OTHERMEDICA

General Provider Information

NPI Number : 1033195656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS CHARLES SPANO M.D.
Provider Business Mailing Address
First Line : 1200 GRANT BLVD W
Second Line :
City : WABASHA
State : MN
Zip : 55981-1042
Country : US
Telephone Number : 651-565-5600
Fax Number :
Provider Business Practice Location Address
First Line : 500 W GRANT ST
Second Line :
City : LAKE CITY
State : MN
Zip : 55041-1143
Country : US
Telephone Number : 651-345-3321
Fax Number : 651-345-1151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 10/01/2018

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Directions to “ DENNIS CHARLES SPANO M.D.” Practice Location

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