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NPI Code Detail

MEDICARE: DR. JOHN DANIEL HOLSTINE MD

MEDICARE: DR. JOHN DANIEL HOLSTINE MD
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
1208800000XUrology Physician19394MN
2208800000XUrology Physician17358IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3341095099OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20951178OTHERIOWA MEDICAL ASSIST.

General Provider Information

NPI Number : 1205833746
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN DANIEL HOLSTINE MD
Provider Business Mailing Address
First Line : 800 MEDICAL CENTER DR
Second Line :
City : FAIRMONT
State : MN
Zip : 56031-4575
Country : US
Telephone Number : 507-235-6036
Fax Number : 507-235-8882
Provider Business Practice Location Address
First Line : 800 MEDICAL CENTER DR
Second Line :
City : FAIRMONT
State : MN
Zip : 56031-4575
Country : US
Telephone Number : 507-235-6036
Fax Number : 507-235-8882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 04/12/2012

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Directions to “ DR. JOHN DANIEL HOLSTINE MD” Practice Location

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