Healthcare Provider Details

I. General information

NPI: 1881640571
Provider Name (Legal Business Name): MARGIT LYNN BRETZKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N SUITE 300
SAINT PAUL MN
55102-2393
US

IV. Provider business mailing address

310 SMITH AVE N STE 300
SAINT PAUL MN
55102-2393
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-5111
  • Fax: 651-241-5512
Mailing address:
  • Phone: 651-241-5111
  • Fax: 651-241-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number29130
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: