Provider Demographics
NPI:1851336101
Name:BANTLE, JOHN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:BANTLE
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 1:420 DELAWARE STREET
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS , MMC 504
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-1960
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET
Practice Address - Street 2:UNIV. OF MN PHYISICIANS, PWB SIXTH FLOOR, CLINIC 6A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21141207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2T126BAOtherBCBS
MN101020OtherUCARE
MN188798000Medicaid
MN33-24523OtherMEDICA CHOICE
MN768007OtherARAZ
MN1008861OtherPREFERRED ONE
MNHP22057OtherHEALTHPARTNERS
MN33-70012OtherMEDICA PRIMARY
MN188798000Medicaid
MN1008861OtherPREFERRED ONE
IA0505131Medicare ID - Type UnspecifiedIA MA
MN2T126BAOtherBCBS