Individual
DR. JOHN PETER BANTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
516 DELAWARE STREET, UNIV. OF MN PHYISICIANS, PWB SIXTH FLOOR, CLINIC 6A, MINNEAPOLIS, MN 55455
(612) 625-8690
Mailing address
420 DELAWARE STREET, UNIVERSITY OF MINNESOTA PHYSICIANS , MMC 504, MINNEAPOLIS, MN 55455
(612) 626-1960
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21141
MN
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
21141
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008861
PREFERRED ONE
MN
01
—
101020
UCARE
MN
05
—
188798000
—
MN
01
—
2T126BA
BCBS
MN
01
—
33-24523
MEDICA CHOICE
MN
01
—
33-70012
MEDICA PRIMARY
MN
01
—
768007
ARAZ
MN
01
—
HP22057
HEALTHPARTNERS
MN
Enumeration date
06/19/2006
Last updated
04/02/2012
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