MEDICARE: DR. MARY E COLBERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	36783	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184601171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E COLBERT MD

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	913 E 26TH ST STE 402
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4515
Country	:	US
Telephone Number	:	612-863-3150
Fax Number	:	612-262-0997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/12/2024

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