Provider Demographics
NPI:1902872641
Name:DETERT, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:DETERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:520 SOUTH SIBLEY AVE
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355
Mailing Address - Country:US
Mailing Address - Phone:320-693-3233
Mailing Address - Fax:320-693-3290
Practice Address - Street 1:1705 N HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1187
Practice Address - Country:US
Practice Address - Phone:507-288-3443
Practice Address - Fax:507-529-6622
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN23504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN467805200Medicaid
MN080011744Medicare ID - Type Unspecified
MN467805200Medicaid