Provider Demographics
NPI:1467552307
Name:PETTIT, ORLO WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ORLO
Middle Name:WILLIAM
Last Name:PETTIT
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 1:712 SOUTH CASCADE STREET
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2813
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-736-8757
Practice Address - Street 1:712 SOUTH CASCADE STREET
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2813
Practice Address - Country:US
Practice Address - Phone:218-736-8000
Practice Address - Fax:218-736-8757
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN935395000Medicaid
MN07-02587OtherMEDICA
ND18957Medicaid
MNHP26723OtherHEALTHPARTNERS
NE41091744413Medicaid
MN1001533OtherPREFERREDONE
MN123446OtherUCAREMN
MN6T020PEOtherBCBS
MN6T020PEOtherBCBS
MNHP26723OtherHEALTHPARTNERS
E45725Medicare UPIN
MN935395000Medicaid