Elizabeth A Detlie, MD
Family Medicine in Shoreview, MN. Individual provider (NPI-1).
NPI number1114933744
StatusActive
Last updated in NPPESOct 14, 2011
Details
- NPI
- 1114933744
- Entity type
- Individual (NPI-1)
- Name
- Elizabeth A Detlie
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 1, 2006
- Last updated
- Oct 14, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 27679 | MN | Yes |
Practice location
404 Highway 96 WShoreview, MN 55126-1900
Phone 651-483-8283 · Fax 651-483-8299
Mailing address
2025 Sloan PlSte 35
Saint Paul, MN 55117-2007
Phone 651-772-1572 · Fax 651-772-1889
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All 33 Family Medicine Physician providers in Shoreview · All 536 providers in Shoreview
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