Provider Demographics
NPI:1104082411
Name:PESEK, ELIZABETH ANN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:PESEK
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 1:2805 DODD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2160
Mailing Address - Country:US
Mailing Address - Phone:651-241-7733
Mailing Address - Fax:651-241-0258
Practice Address - Street 1:2805 DODD RD STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2160
Practice Address - Country:US
Practice Address - Phone:651-241-7733
Practice Address - Fax:651-241-0258
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND13661207V00000X
MN52858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology