Basic Information
| Provider Information | |||||||||
| NPI: | 1457916470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEETER | ||||||||
| FirstName: | LANCE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1226290006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1217 8TH ST N | ||||||||
| Address2: | |||||||||
| City: | NEW ULM | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560731552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072175000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 67902 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.