Provider Demographics
NPI:1770537581
Name:NORRIS, MARY K (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST # MR 11326
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-7560
Mailing Address - Fax:612-863-3809
Practice Address - Street 1:800 E 28TH ST # MR 11326
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-7560
Practice Address - Fax:612-863-3809
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN37194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN941023600Medicare ID - Type Unspecified
110005042Medicare UPIN
G26684Medicare UPIN