MEDICARE: DR. CHRISTINA ELAINE DEWEY 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	208000000X	Pediatrics Physician	43301	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	142968	OTHER	MN	UCARE
2	295J4HI	OTHER	MN	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1202287	OTHER	MN	MEDICA
5	CP9041032171	OTHER	MN	PREFERRED ONE

General Provider Information

NPI Number	:	1700858487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA ELAINE DEWEY M.D.

Provider Business Mailing Address
First Line	:	4500 XERXES AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1419
Country	:	US
Telephone Number	:	612-730-9300
Fax Number	:	612-500-4813

Provider Business Practice Location Address
First Line	:	4500 XERXES AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-1419
Country	:	US
Telephone Number	:	612-730-9300
Fax Number	:	612-500-4813

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	08/31/2022

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