1699765206 NPI number — ANN DOBERSTEIN MD

Table of content: ANN DOBERSTEIN MD (NPI 1699765206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699765206 NPI number — ANN DOBERSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBERSTEIN
Provider First Name:
ANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699765206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4190 LOBERG AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55811-2652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-249-5700
Provider Business Mailing Address Fax Number:
218-249-4666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4190 LOBERG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55811-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-249-5700
Provider Business Practice Location Address Fax Number:
218-249-4666
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35369 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-04590 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33335700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN1041016555 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111180P498 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90D75DO . This is a "BCBSMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: C013 . This is a "TRICARE WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP26561 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 174268000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com