Individual
BRENT D. PLACKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
970 PICKETT ST N, BAYPORT, MN 55003-1489
(651) 779-5713
(651) 747-1621
Mailing address
2277 HIGHWAY 36 W STE 140, ROSEVILLE, MN 55113-3895
(612) 255-0628
(612) 255-0647
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11906
MN
363A00000X
Physician Assistant
865-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004156125
MEDICARE NUMBER
WI
05
—
42958400
—
WI
Enumeration date
08/30/2005
Last updated
01/19/2018
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