Provider Demographics
NPI:1083631584
Name:DUMMIT, MARC C (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:C
Last Name:DUMMIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:PO BOX 5600
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-0006
Mailing Address - Country:US
Mailing Address - Phone:507-457-4160
Mailing Address - Fax:507-457-4160
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-0006
Practice Address - Country:US
Practice Address - Phone:507-457-4160
Practice Address - Fax:507-457-4160
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN39556207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN53A34DUOtherBLUE CROSS BLUE SHIELD
WI34151500OtherMA
E14026Medicare UPIN