Provider Demographics
NPI:1437246808
Name:TORSETH, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:TORSETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843763
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-3763
Mailing Address - Country:US
Mailing Address - Phone:623-974-1500
Mailing Address - Fax:
Practice Address - Street 1:800 FREEPORT AVE NW
Practice Address - Street 2:STE 100A
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2723
Practice Address - Country:US
Practice Address - Phone:763-257-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42825207R00000X
MN31571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE06314Medicare UPIN
MN826895900Medicare ID - Type Unspecified