MEDICARE: DR. BETTY A OLIVARES PAKZAD 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35787	MN

General Provider Information

NPI Number	:	1538129374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTY A OLIVARES PAKZAD MD

Provider Business Mailing Address
First Line	:	NW 6164
Second Line	:	PO BOX 1450
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55485-6164
Country	:	US
Telephone Number	:	877-861-9294
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 OAKDALE AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55422-2926
Country	:	US
Telephone Number	:	763-581-4150
Fax Number	:	763-581-4151

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	03/13/2014

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