Provider Demographics
NPI:1699979492
Name:LORENTZ, DUSTIN ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ALEXANDER
Last Name:LORENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:610 30TH AVE W
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3426
Mailing Address - Country:US
Mailing Address - Phone:320-763-5123
Mailing Address - Fax:320-763-5749
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5273
Practice Address - Country:US
Practice Address - Phone:320-763-5123
Practice Address - Fax:320-763-5749
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56197207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1699979492Medicaid
MN56197OtherMN MEDICAL LICENSE
MN1699979492OtherNPI
MNFL4280385OtherDEA
MNH400149259Medicare PIN