Healthcare Provider Details

I. General information

NPI: 1609875509
Provider Name (Legal Business Name): ROBERTA M MIDWINTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 4TH ST NO
WINSTED MN
55395-0000
US

IV. Provider business mailing address

PO BOX 718
WINSTED MN
55395-0718
US

V. Phone/Fax

Practice location:
  • Phone: 320-485-4803
  • Fax: 320-485-4499
Mailing address:
  • Phone: 320-485-4803
  • Fax: 320-485-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38263
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: