Provider Demographics
NPI:1881640571
Name:BRETZKE, MARGIT LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGIT
Middle Name:LYNN
Last Name:BRETZKE
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 1:310 SMITH AVE N
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2393
Mailing Address - Country:US
Mailing Address - Phone:651-241-5111
Mailing Address - Fax:651-241-5512
Practice Address - Street 1:310 SMITH AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2393
Practice Address - Country:US
Practice Address - Phone:651-241-5111
Practice Address - Fax:651-241-5512
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101597D417OtherUCARE
MN1700453OtherMEDICA
MN30703100OtherWISCONSIN MA
MN727775000Medicaid
MNHP22930OtherHEALTHPARTNERS
MN36D56BROtherBLUE CROSS BLUE SHIELD
MN101597D417OtherUCARE
MN020001533Medicare ID - Type Unspecified