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NPI Code Detail

MEDICARE: ABBY M DETTMER DO

MEDICARE: ABBY M DETTMER DO
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 PhysicianR-7613IA
2207Q00000XFamily Medicine Physician50395MN

General Provider Information

NPI Number : 1891706263
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABBY M DETTMER DO
Provider Business Mailing Address
First Line : 1575 LOOKOUT DR
Second Line :
City : NORTH MANKATO
State : MN
Zip : 56003-2503
Country : US
Telephone Number : 507-625-1811
Fax Number :
Provider Business Practice Location Address
First Line : 1575 LOOKOUT DR
Second Line :
City : NORTH MANKATO
State : MN
Zip : 56003-2503
Country : US
Telephone Number : 507-625-1811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 11/09/2023

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