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NPI Code Detail

MEDICARE: DR. MARI B ITO MD

MEDICARE: DR. MARI B ITO 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
1207P00000XEmergency Medicine Physician33781MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
233781OTHERMNMN MEDICAL LICENSE

General Provider Information

NPI Number : 1467429621
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARI B ITO MD
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-1166
Fax Number :
Provider Business Practice Location Address
First Line : 9055 SPRINGBROOK DR NW
Second Line : URGENCY CARE
City : COON RAPIDS
State : MN
Zip : 55433-5841
Country : US
Telephone Number : 763-236-7144
Fax Number : 763-236-7733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 07/23/2015

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