Provider Demographics
NPI:1063651768
Name:PIDCOCK, JUSTINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:MARIE
Last Name:PIDCOCK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:701 PARK AVE # P7
Mailing Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER/REVENUE MANAGEMENT
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-2300
Mailing Address - Fax:612-904-4527
Practice Address - Street 1:701 PARK AVE # P7
Practice Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER/REVENUE MANAGEMENT
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2300
Practice Address - Fax:612-904-4527
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-12-11
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Provider Licenses
StateLicense IDTaxonomies
MN52330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine