Provider Demographics
NPI:1609851229
Name:UTZ, MAUREEN PAULY (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PAULY
Last Name:UTZ
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 1:675 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3072
Mailing Address - Country:US
Mailing Address - Phone:952-442-3188
Mailing Address - Fax:952-442-7861
Practice Address - Street 1:675 WATER ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-3072
Practice Address - Country:US
Practice Address - Phone:952-442-3188
Practice Address - Fax:952-442-7861
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30857207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN385302100Medicaid
D98260Medicare UPIN
MN385302100Medicaid