Provider Demographics
NPI:1609875509
Name:MIDWINTER, ROBERTA M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M
Last Name:MIDWINTER
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:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-0718
Mailing Address - Country:US
Mailing Address - Phone:320-485-4803
Mailing Address - Fax:320-485-4499
Practice Address - Street 1:551 4TH ST NO
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-0000
Practice Address - Country:US
Practice Address - Phone:320-485-4803
Practice Address - Fax:320-485-4499
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38263OtherMEDICAL LICENSE
MN866727600Medicaid
MN38263OtherMEDICAL LICENSE