ELIZABETH A DETLIE (NPI# 1114933744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114933744 |
| Entity Type | Individual |
| Full Name | ELIZABETH A DETLIE |
| Credential | MD |
| Practice Address |
404 Highway 96 W Shoreview MN 55126-1900 |
| Mailing Address |
2025 Sloan Pl Ste 35 Saint Paul MN 55117-2007 |
| Practice Telephone | 6514838283 |
| Practice Fax Number | 6514838299 |
| Mailing Telephone | 6517721572 |
| Mailing Fax Number | 6517721889 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-10-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 27679 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 129886100 | 05 |
| Street Address |
404 HIGHWAY 96 W |
| City | SHOREVIEW |
| State | MN |
| Zip Code | 55126-1900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356365993 | Bruce H Leppink | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2006-07-27 |
| 1659939494 | Bryan Alm | Physical Therapist | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2019-06-05 |
| 1982133476 | Lynn Sedlack | Nurse Practitioner | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2017-06-08 |
| 1619157344 | Family Healthservices Minnesota, P.a. Dba Entira Family Clinics | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1901 | 2007-11-09 |
| 1598967390 | Katherine Elizabeth Lazenby | Physical Therapist | 404 Highway 96 W, Suite E, Shoreview, MN 55126-1901 | 2007-06-04 |
| 1407073513 | Minnhealth Family Physicians, P.a. | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1901 | 2007-04-19 |
| 1447391420 | Family Healthservices Minnesota, P.a | Non-Pharmacy Dispensing Site | 404 Highway 96 W, Shoreview, MN 55126-1901 | 2007-02-10 |
| 1386655488 | Garrett R Trobec | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2006-08-11 |
| 1568473650 | Cynthia M Frane | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2006-08-11 |
| 1407863178 | Robert R Weber | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2006-08-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174184964 | Natural Smiles Dental Care | Clinic/Center | 3434 Lexington Ave. N, Suite 700, Shoreview, MN 55126 | 2019-06-24 |
| 1588194740 | Michael Simons | Hearing Instrument Specialist | 1007 Tiller Lane, Shoreview, MN 55126 | 2017-06-19 |
| 1902255441 | Latarsha Nicole Bronaugh | Counselor | 3490 Lexington Ave North, Suite 205, Shoreview, MN 55126 | 2016-06-06 |
| 1265809479 | Emily Elizabeth Bade | Social Worker | 3490 Lexington Ave. N, Suite 205, Shoreview, MN 55126 | 2015-08-24 |
| 1669857520 | Laurel Ann Walsh | Marriage & Family Therapist | 3490 Lexington Ave. N., Suite 205, Shoreview, MN 55126 | 2015-07-21 |
| 1598150930 | Nova Bhs | Psychologist | 521 Tanglewood Dr., Shoreview, MN 55126 | 2015-04-02 |
| 1144570714 | Healthstat Arkansas/pace Ind.- St. Paul | Preventive Medicine | 3737 Lexington Ave. N, St. Paul, MN 55126 | 2012-09-11 |
| 1679843619 | Shoreview Dental Associates | Dentist | 4700 Lexington Avenue N, Suite D, Shoreview, MN 55126 | 2012-01-09 |
| 1700039575 | Jacqueline Elizabeth Hoppenrath | Audiologist | 4570 Churchill St Ste 130, Shoreview, MN 55126 | 2008-10-24 |
| 1164545935 | Lucia Jane Lein | Chiropractor | 1000 W. County Rd. E, 210, Shoreview, MN 55126 | 2007-04-09 |
| Find all providers in zip 55126 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356365993 | Bruce H Leppink | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1900 | 2006-07-27 |
| 1689602153 | John J Salchert | Family Medicine | 5895 Prairie Ridge Dr, Shoreview, MN 55126-5003 | 2006-06-30 |
| 1992148738 | Courtney L Messerly | Family Medicine | 4194 Lexington Ave N, Shoreview, MN 55126-6106 | 2013-04-11 |
| 1275851735 | Jeffrey Nelson | Family Medicine | 4194 Lexington Ave N, Shoreview, MN 55126-6106 | 2010-05-08 |
| 1295994028 | Seth A Vogel | Family Medicine | 4194 Lexington Ave N, Shoreview, MN 55126-6106 | 2008-06-06 |
| 1194999672 | Lizabeth E. Larson | Family Medicine | 4194 Lexington Ave N, Shoreview, MN 55126-6106 | 2008-04-16 |
| 1619157344 | Family Healthservices Minnesota, P.a. Dba Entira Family Clinics | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1901 | 2007-11-09 |
| 1912110750 | Majken Anne Schwartz | Family Medicine | 4194 Lexington Ave N, Shoreview, MN 55126-6106 | 2007-05-08 |
| 1407073513 | Minnhealth Family Physicians, P.a. | Family Medicine | 404 Highway 96 W, Shoreview, MN 55126-1901 | 2007-04-19 |
| 1255468914 | Brandy Lee Utter | Family Medicine | 4194 Lexington Ave N, Shoreview, MN 55126-6106 | 2007-02-28 |
| Find all providers in SHOREVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.