Provider Demographics
NPI:1942271911
Name:WALDSCHMIDT, MARILYN K (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:K
Last Name:WALDSCHMIDT
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 1:212 LAKE ST E
Mailing Address - Street 2:WATERVILLE CLINIC - MAYO HEALTH SYSTEM
Mailing Address - City:WATERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56096-1450
Mailing Address - Country:US
Mailing Address - Phone:507-362-4221
Mailing Address - Fax:507-362-4361
Practice Address - Street 1:212 LAKE ST E
Practice Address - Street 2:WATERVILLE CLINIC - MAYO HEALTH SYSTEM
Practice Address - City:WATERVILLE
Practice Address - State:MN
Practice Address - Zip Code:56096-1450
Practice Address - Country:US
Practice Address - Phone:507-362-4221
Practice Address - Fax:507-362-4361
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21483OtherSVHP
MNHP23277OtherHEALTH PARTNERS
MN39T06WA, 37Y47WAOtherBCBS
MN0101633, 3909161OtherMEDICA
MN120312OtherMNCARE-U
MN39T06WA, 37Y47WAOtherMNCARE
MNNA9501017105OtherPREFERRED ONE
MNNA9501017105OtherPREFERRED ONE
MN080006813, 080005053Medicare ID - Type Unspecified