Provider Demographics
NPI:1497735419
Name:PLOTNIK, TAMMI S (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMI
Middle Name:S
Last Name:PLOTNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMMI
Other - Middle Name:S
Other - Last Name:YOUSSEF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1804 7TH ST W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2300
Mailing Address - Country:US
Mailing Address - Phone:651-227-7806
Mailing Address - Fax:651-256-6766
Practice Address - Street 1:233 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-227-7806
Practice Address - Fax:651-256-6707
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43428208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1497735419Medicaid
MN1497735419Medicaid
MN657673700Medicaid