Provider Demographics
NPI:1457434946
Name:SAFO, ANN L (DO)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:SAFO
Suffix:
Gender:F
Credentials:DO
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 2168
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-2168
Mailing Address - Country:US
Mailing Address - Phone:701-234-2119
Mailing Address - Fax:
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5800
Practice Address - Country:US
Practice Address - Phone:701-234-8830
Practice Address - Fax:701-234-8950
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP54864OtherHEALTHPARTNERS/URGENT CAR
MN006686900Medicaid
ND81276Medicaid
MN106789OtherUCARE/URGENT CARE
MN399G9SAOtherBCBS
MN66-08641OtherMEDICA/URGENT CARE
MN1032683OtherPREFERRED ONE/URGENT CARE
WI43523300Medicaid
IA0596262Medicaid
ND81276Medicaid
MN66-08641OtherMEDICA/URGENT CARE
NDN720469Medicare PIN