Portilla, George A

Portilla, George A is an individual health care provider with primary practice located at 1027 Washington Ave , Detroit Lakes MN 56501-3409. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Portilla, George A can be contacted via phone (218) 847-5611.

Contact Information

Primary practice address
1027 Washington Ave Detroit Lakes MN 56501-3409
Phone: (218) 847-5611
Fax: (218) 847-0881
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 27750 Minnesota

Profile Details

NPI number 1245287010
LBN Legal business name Portilla, George A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2006
Last updated Nov 21st, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245287010 NPPES
Minnesota Other 16691B1 MNBS #
Minnesota Other 1700491 MNBS #
Minnesota Other 1669B2 MNBS #
Minnesota Other MN200018 MNBS #
Minnesota MEDICAID 036267100 MNBS #
Minnesota Other 572128 MNBS #
Minnesota Other HP25820 MNBS #
Minnesota MEDICAID 13280 MNBS #
Minnesota Other 142047 MNBS #
Minnesota Other 16691PO MNBS #
Minnesota Other 2611 MNBS #
Minnesota Other DA9031015667 MNBS #

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