Healthcare Provider Details

I. General information

NPI: 1154466209
Provider Name (Legal Business Name): ROBIN C MARUSHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN CLARE ENGBERG MD

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE CENTRACARE CLINIC WOMENS & CHILDRENS
ST CLOUD MN
56303
US

IV. Provider business mailing address

1900 CENTRACARE CIRCLE CENTRACARE CLINIC WOMENS & CHILDRENS
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3630
  • Fax:
Mailing address:
  • Phone: 320-654-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17834
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50430
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: