Provider Demographics
NPI:1003686684
Name:DTG II PLLC
Entity Type:Organization
Organization Name:DTG II PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-268-7713
Mailing Address - Street 1:811 E KENT RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9791
Mailing Address - Country:US
Mailing Address - Phone:800-268-7713
Mailing Address - Fax:415-704-3294
Practice Address - Street 1:3819 TESSON CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7737
Practice Address - Country:US
Practice Address - Phone:800-268-7713
Practice Address - Fax:415-704-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty