Provider Demographics
NPI:1508835422
Name:VINT, MARK M
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:VINT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2405
Mailing Address - Country:US
Mailing Address - Phone:612-588-9411
Mailing Address - Fax:612-588-8066
Practice Address - Street 1:3300 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2405
Practice Address - Country:US
Practice Address - Phone:612-588-9411
Practice Address - Fax:612-588-8066
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080015937Medicare Oscar/Certification
MNI50083Medicare UPIN