Provider Demographics
NPI:1134118920
Name:MAREK, PAUL L (MD, FHM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:MAREK
Suffix:
Gender:M
Credentials:MD, FHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SIXTH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 SIXTH AVE N
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47533207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043620OtherPREFERRED ONE
286G5MAOtherBLUE CROSS BLUE SHIELD
HP50083OtherHEALTH PARTNERS
132808OtherU-CARE
0407470OtherMEDICA HEALTH PLANS
106686200OtherMEDICAL ASSISTANCE
MN106686200Medicaid
2335151OtherARAZ GROUP/AMERICA'S PPO
132808OtherU-CARE
2335151OtherARAZ GROUP/AMERICA'S PPO