Provider Demographics
NPI:1295782308
Name:PLUNKETT, MICHAEL B (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:PLUNKETT
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 1:607 IVY FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1945
Mailing Address - Country:US
Mailing Address - Phone:651-450-5951
Mailing Address - Fax:
Practice Address - Street 1:607 IVY FALLS AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-1945
Practice Address - Country:US
Practice Address - Phone:651-450-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN366762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300085346OtherRAILROAD MEDICARE MN
MN23003OtherAMERICA'S PPO
MN029R0PLOtherBLUE CROSS
MN104198OtherUCARE
MNHP14184OtherHEALTHPARTNERS
MN1000214OtherPREFERRED ONE
MN535563000Medicaid
MN2M442PLOtherBLUE CROSS
MN300085346OtherRAILROAD MEDICARE MN
WI34512800Medicaid
MN300085346OtherRAILROAD MEDICARE MN
MN029R0PLOtherBLUE CROSS
MNHP14184OtherHEALTHPARTNERS
IA0538108Medicaid