MEDICARE: MARI SPITALE PA-C

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	363A00000X	Physician Assistant	14653	MN

General Provider Information

NPI Number	:	1811668585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI SPITALE PA-C

Provider Business Mailing Address
First Line	:	8170 33RD AVE S # MS 21110Q
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7532 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3101
Country	:	US
Telephone Number	:	763-560-3050
Fax Number	:

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

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	12/09/2025

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