1881640571 NPI number — DR. MARGIT LYNN BRETZKE M.D.

Table of content: DR. MARGIT LYNN BRETZKE M.D. (NPI 1881640571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881640571 NPI number — DR. MARGIT LYNN BRETZKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRETZKE
Provider First Name:
MARGIT
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1881640571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 SMITH AVE N
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102-2393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-241-5111
Provider Business Mailing Address Fax Number:
651-241-5512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 SMITH AVE N
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-241-5111
Provider Business Practice Location Address Fax Number:
651-241-5512
Provider Enumeration Date:
05/25/2006

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: 174400000X , with the licence number:  29130 , 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: 101597D417 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1700453 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30703100 . This is a "WISCONSIN MA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 727775000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP22930 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 36D56BR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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