Provider Demographics
NPI:1033202981
Name:JOSEPH, MARILYN SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:SUSAN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:410 CHURCH ST SE
Mailing Address - Street 2:BOYNTON HEALTH SERVICE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0340
Mailing Address - Country:US
Mailing Address - Phone:612-625-5187
Mailing Address - Fax:612-625-0902
Practice Address - Street 1:410 CHURCH ST SE
Practice Address - Street 2:BOYNTON HEALTH SERVICE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0340
Practice Address - Country:US
Practice Address - Phone:612-625-5187
Practice Address - Fax:612-625-0902
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2T433JOOtherBCBS
MNHP16488OtherHEALTH PARTNERS
MN0770062OtherMEDICA-PRIMARY
MN100734OtherU CARE
ND10387Medicaid
IA0541011Medicaid
MN1000089OtherPREFERRED ONE
MN013847OtherFAIRVIEW
SD7777470Medicaid
MN07-24902OtherMEDICA-CHOICE
WI30199300Medicaid
764324OtherARAZ
MN0770062OtherMEDICA-PRIMARY