Provider Demographics
NPI:1538129374
Name:OLIVARES PAKZAD, BETTY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:A
Last Name:OLIVARES PAKZAD
Suffix:
Gender:F
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:NW 6164
Mailing Address - Street 2:PO BOX 1450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-6164
Mailing Address - Country:US
Mailing Address - Phone:877-861-9294
Mailing Address - Fax:
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-581-4150
Practice Address - Fax:763-581-4151
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35787207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44907Medicare UPIN