Provider Demographics
NPI:1295770857
Name:HORDVIK, MARIT K (MD)
Entity type:Individual
Prefix:
First Name:MARIT
Middle Name:K
Last Name:HORDVIK
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1707 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-6050
Practice Address - Country:US
Practice Address - Phone:701-231-7331
Practice Address - Fax:701-231-6132
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3T417HOOtherMNBS #
NDDA9011015645OtherPREFERRED ONE #
NDHP19492OtherHEALTHPARTNERS #
ND0105957OtherMEDICA #
ND0114783OtherMEDICA #
NDND100031OtherLHS #
ND142312OtherUCARE #
ND55A98HOOtherMNBS #
ND053897300Medicaid
ND5D241HOOtherMNBS #
ND17041Medicaid
ND0114922OtherMEDICA #
ND11676OtherNDBS #
ND2M611HOOtherMNBS #
MN3T639HOOtherMNBS #
ND574997OtherAMERICA'S PPO/ARAZ #
ND11676Medicare ID - Type UnspecifiedND MEDICARE #
ND0114922OtherMEDICA #
NDDA9011015645OtherPREFERRED ONE #
ND053897300Medicaid