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NPI Code Detail

MEDICARE: DR. MARY K MARTINIE M.D.

MEDICARE: DR. MARY K MARTINIE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician01056942AIN
2207V00000XObstetrics & Gynecology Physician103949MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720015316
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY K MARTINIE M.D.
Provider Business Mailing Address
First Line : 5700 BOTTINEAU BLVD
Second Line : #210
City : CRYSTAL
State : MN
Zip : 55429-3183
Country : US
Telephone Number : 763-587-7000
Fax Number : 763-587-7015
Provider Business Practice Location Address
First Line : 5700 BOTTINEAU BLVD
Second Line : #210
City : CRYSTAL
State : MN
Zip : 55429-3183
Country : US
Telephone Number : 763-587-7000
Fax Number : 763-587-7015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 06/18/2014

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