Provider Demographics
NPI:1215149364
Name:JOHN M ENGER, PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:JOHN M ENGER, PROFESSIONAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-373-6133
Mailing Address - Street 1:904 E PLAZA STREET
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007
Mailing Address - Country:US
Mailing Address - Phone:507-373-6133
Mailing Address - Fax:507-373-0261
Practice Address - Street 1:904 E PLAZA STREET
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007
Practice Address - Country:US
Practice Address - Phone:507-373-6133
Practice Address - Fax:507-373-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN803725600Medicaid
IA0491043Medicaid
MN236266000Medicaid
IA0953471Medicaid
MN480027955OtherMEDICARE RAILROAD
MNCS1038OtherMEDICARE RAILROAD
MNP00309735OtherMEDICARE RAILROAD
MN213825500Medicaid
MNCS1038OtherMEDICARE RAILROAD
MNT65486Medicare UPIN
MNT78422Medicare UPIN
IA0953471Medicaid
MN213825500Medicaid
MN0808750001Medicare NSC