Provider Demographics
NPI:1700878972
Name:ZENKER, BERNARDA M (MD)
Entity Type:Individual
Prefix:
First Name:BERNARDA
Middle Name:M
Last Name:ZENKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2434 E 117TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1295
Mailing Address - Country:US
Mailing Address - Phone:952-465-3883
Mailing Address - Fax:952-465-3885
Practice Address - Street 1:2434 E 117TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1295
Practice Address - Country:US
Practice Address - Phone:952-465-3883
Practice Address - Fax:952-465-3885
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN42380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103475800Medicaid
MN103475800Medicaid
080010384Medicare ID - Type Unspecified