Provider Demographics
NPI:1932296431
Name:BROOKS, MARVIN A (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4435
Mailing Address - Country:US
Mailing Address - Phone:763-520-2200
Mailing Address - Fax:
Practice Address - Street 1:8301 GOLDEN VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4435
Practice Address - Country:US
Practice Address - Phone:763-520-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80010985Medicare ID - Type Unspecified
MNA94954Medicare UPIN