Provider Demographics
NPI:1265460117
Name:PIETRAFITTA, JOSEPH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:PIETRAFITTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 UPLAND LN N
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4470
Mailing Address - Country:US
Mailing Address - Phone:763-416-0676
Mailing Address - Fax:763-416-0476
Practice Address - Street 1:9325 UPLAND LN N
Practice Address - Street 2:SUITE 205
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4470
Practice Address - Country:US
Practice Address - Phone:763-416-0676
Practice Address - Fax:763-416-0476
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33405174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN551202600Medicaid
MNA59379Medicare UPIN
MN029000224Medicare PIN