MEDICARE: RICHARD J. DANNENBERG

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
1	332H00000X	Eyewear Supplier	27830	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110565	OTHER	MN	EYEMED
2	826041022794	OTHER	MN	PREFERRED ONE
3	0808759	OTHER	MN	MEDICA
4	114683	OTHER	MN	U-CARE
5	5C212DA	OTHER	MN	BCBS BLUE PLUS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	19379	OTHER	MN	HEALTH PARTNERS
8	43034DA	OTHER	MN	BCBSMN

General Provider Information

NPI Number	:	1205951415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD J. DANNENBERG

Provider Business Mailing Address
First Line	:	2023 S BROADWAY ST
Second Line	:
City	:	NEW ULM
State	:	MN
Zip	:	56073-3954
Country	:	US
Telephone Number	:	507-233-3500
Fax Number	:	507-354-7562

Provider Business Practice Location Address
First Line	:	2023 S BROADWAY ST
Second Line	:
City	:	NEW ULM
State	:	MN
Zip	:	56073-3954
Country	:	US
Telephone Number	:	507-233-3500
Fax Number	:	507-354-7562

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD JOSEPH DANNENBERG
Credential	:	MD
Telephone Number	:	507-233-3500

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/16/2008

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