Provider Demographics
NPI:1467568501
Name:AHRENDT, MARK N (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:AHRENDT
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:NORTH MEMORIAL TRAUMA SERVICES
Mailing Address - Street 2:3300 OAKDALE AVE NORTH
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-520-7647
Mailing Address - Fax:763-520-1022
Practice Address - Street 1:NORTH MEMORIAL HEALTH CARE
Practice Address - Street 2:3300 OAKDALE AVE NORTH
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-520-7647
Practice Address - Fax:763-520-1022
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33948208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
410729979OtherHEALTH PARTNERS
1000817OtherPREFERRED ONE
1700227OtherMEDICA
WI31681100Medicaid
2M848AHOtherBLUE CROSS BLUE SHIELD
MN964303600Medicaid
2M848AHOtherBLUE CROSS BLUE SHIELD
1000817OtherPREFERRED ONE