Provider Demographics
NPI:1932122777
Name:VOTEL, JOANNE BERTHIAUME (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:BERTHIAUME
Last Name:VOTEL
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 1:2945 HAZELWOOD ST
Mailing Address - Street 2:STE 210
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1241
Mailing Address - Country:US
Mailing Address - Phone:651-770-3320
Mailing Address - Fax:651-770-3684
Practice Address - Street 1:1737 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2185
Practice Address - Country:US
Practice Address - Phone:651-770-3320
Practice Address - Fax:651-770-3684
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN30640207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN569788300Medicaid
B58426Medicare UPIN
160000516Medicare ID - Type Unspecified