Provider Demographics
NPI:1558378026
Name:PINTO, MARCOS H (MD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:H
Last Name:PINTO
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 1:251 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MN
Mailing Address - Zip Code:56175-1536
Mailing Address - Country:US
Mailing Address - Phone:507-629-3520
Mailing Address - Fax:507-212-4199
Practice Address - Street 1:251 5TH ST E
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:MN
Practice Address - Zip Code:56175-1536
Practice Address - Country:US
Practice Address - Phone:507-629-3520
Practice Address - Fax:507-212-4199
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20952208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00230403Medicare PIN
B58328Medicare UPIN
MN340000839Medicare PIN