Provider Demographics
NPI:1346231867
Name:JOLKOVSKY, MERRYN R (MD)
Entity Type:Individual
Prefix:
First Name:MERRYN
Middle Name:R
Last Name:JOLKOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 SIXTH AVE N
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 SIXTH AVE N
Practice Address - Street 2:CENTRACARE CLINIC
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38835207RN0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
600884OtherARAZ GROUP AMERICAS PPO
1011481OtherPREFERRED ONE
112147OtherUCARE
HP25459OtherHEALTH PARTNERS
1616743OtherFIRST HEALTH PLAN
3100291 (PL)OtherMEDICA HEALTH PLANS
110126975OtherRR MEDICARE
30T90JOOtherBLUE CROSS BLUE SHIELD
3107424OtherMEDICA HEALTH PLANS
926318700OtherMEDICAL ASSISTANCE
926318700OtherMEDICAL ASSISTANCE
30T90JOOtherBLUE CROSS BLUE SHIELD
E17120Medicare UPIN