Provider Demographics
NPI:1932256948
Name:NETT, MARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:S
Last Name:NETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:925 E SUPERIOR ST
Mailing Address - Street 2:STE 109
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2238
Mailing Address - Country:US
Mailing Address - Phone:218-722-3700
Mailing Address - Fax:
Practice Address - Street 1:925 E SUPERIOR ST
Practice Address - Street 2:SUITE 109
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2238
Practice Address - Country:US
Practice Address - Phone:218-722-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN311302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE02377Medicare UPIN