Individual
GEORGE A PORTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27750
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036267100
—
MN
05
—
13280
—
MN
01
—
142047
UCARE #
MN
01
—
16691B1
MNBS #
MN
01
—
16691PO
MNBS #
MN
01
—
1669B2
MNBS #
MN
01
—
1700491
MEDICA #
MN
01
—
2611
NDBS #
MN
01
—
572128
AMERICA'S PPO/ARAZ #
MN
01
—
DA9031015667
PREFERRED ONE #
MN
01
—
HP25820
HEALTHPARTNERS #
MN
01
—
MN200018
LHS/BANNERHEALTH #
MN
Enumeration date
05/27/2006
Last updated
11/21/2011
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