Healthcare Provider Details

I. General information

NPI: 1346747284
Provider Name (Legal Business Name): TATIANA MAMALIGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 HWY 36 W STE. 100
ROSEVILLE MN
55113
US

IV. Provider business mailing address

2355 HWY 36 W STE. 100
ROSEVILLE MN
55113
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-2000
  • Fax:
Mailing address:
  • Phone: 651-292-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number87748-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2025004879
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number82623
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24590
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: