Provider Demographics
NPI:1831312933
Name:HUNTLEY, MARNIE TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:TAYLOR
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5301 YORK AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2134
Mailing Address - Country:US
Mailing Address - Phone:612-963-2553
Mailing Address - Fax:
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN582392080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine