Healthcare Provider Details

I. General information

NPI: 1447222963
Provider Name (Legal Business Name): MARTHA RUTH ENGELBREKT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA RUTH BAUMGARTNER MD

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 RIDGEDALE DR SUITE 100
MINNETONKA MN
55305-1753
US

IV. Provider business mailing address

14001 RIDGEDALE DR SUITE 100
MINNETONKA MN
55305-1753
US

V. Phone/Fax

Practice location:
  • Phone: 952-473-0211
  • Fax: 952-473-7908
Mailing address:
  • Phone: 952-473-0211
  • Fax: 952-473-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: