MEDICARE: DR. MARY HROSCIKOSKI M.D.

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	207Q00000X	Family Medicine Physician	26252	MN

General Provider Information

NPI Number	:	1548564909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY HROSCIKOSKI M.D.

Provider Business Mailing Address
First Line	:	116 8TH AVE SE
Second Line	:
City	:	LITTLE FALLS
State	:	MN
Zip	:	56345-3539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 8TH AVE SE
Second Line	:
City	:	LITTLE FALLS
State	:	MN
Zip	:	56345-3539
Country	:	US
Telephone Number	:	320-632-2981
Fax Number	:

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

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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