Provider Demographics
NPI:1417934969
Name:BARDO-MARTINSON, ALISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:M
Last Name:BARDO-MARTINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALISA
Other - Middle Name:M
Other - Last Name:BARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:612-262-4258
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:651-635-9173
Practice Address - Fax:651-628-2999
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47611207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine