Provider Demographics
NPI:1851071146
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:DR
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 1:101 S REID ST STE 307
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7045
Practice Address - Country:US
Practice Address - Phone:800-268-7713
Practice Address - Fax:415-704-3294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DTG II PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty