Provider Demographics
NPI:1578564092
Name:NEESE, DAVID JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:NEESE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3790 117TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2666
Mailing Address - Country:US
Mailing Address - Phone:763-421-7300
Mailing Address - Fax:763-421-3337
Practice Address - Street 1:3790 117TH LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2666
Practice Address - Country:US
Practice Address - Phone:763-421-7300
Practice Address - Fax:763-421-3337
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN475213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33942OtherHEALTH PARTNERS
MN111899OtherUCARE
MN794225700Medicaid
MN2700024OtherMEDICA
MN7B214NEOtherBLUE CROSS BLUE SHIELD
MN1002520001Medicare NSC
MN7B214NEOtherBLUE CROSS BLUE SHIELD
MN2700024OtherMEDICA