MEDICARE: MICHAEL B PLUNKETT 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
1	2085R0202X	Diagnostic Radiology Physician	36676	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300085346	OTHER	MN	RAILROAD MEDICARE MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	23003	OTHER	MN	AMERICA'S PPO
3	029R0PL	OTHER	MN	BLUE CROSS
4	104198	OTHER	MN	UCARE
5	HP14184	OTHER	MN	HEALTHPARTNERS
6	1000214	OTHER	MN	PREFERRED ONE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	2M442PL	OTHER	MN	BLUE CROSS

General Provider Information

NPI Number	:	1295782308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL B PLUNKETT M.D.

Provider Business Mailing Address
First Line	:	607 IVY FALLS AVE
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-1945
Country	:	US
Telephone Number	:	651-450-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 IVY FALLS AVE
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-1945
Country	:	US
Telephone Number	:	651-450-5951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	01/20/2022

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Directions to “ MICHAEL B PLUNKETT M.D.” Practice Location

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