Provider Demographics
NPI:1053480103
Name:CARY, BRENDA LEE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:CARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 9TH STREET NORTH
Mailing Address - Street 2:ESSENTIA HEALTH VIRGINIA CLINIC
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792
Mailing Address - Country:US
Mailing Address - Phone:218-741-0150
Mailing Address - Fax:715-588-7884
Practice Address - Street 1:1101 9TH STREET NORTH
Practice Address - Street 2:DULUTH CLINIC - VIRGINIA
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792
Practice Address - Country:US
Practice Address - Phone:218-741-0150
Practice Address - Fax:715-588-7884
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN53547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34743000Medicaid
WI1053480103OtherBCBS
MN1053480103OtherBCBS
MN1053480103OtherBCBS