Provider Demographics
NPI:1104841295
Name:KLINKER, MARY THERESE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESE
Last Name:KLINKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:THERESE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3559
Mailing Address - Country:US
Mailing Address - Phone:320-631-7000
Mailing Address - Fax:320-632-0534
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7000
Practice Address - Fax:320-632-0534
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101031OtherMEDICA
MNA015OtherTRICARE
NA9231013065OtherPREFERRED ONE
MN102868C736OtherUCARE MINNESOTA
21627OtherAMERICA'S PPO
MN5T131KLOtherBCBS OF MINNESOTA
MN981819700Medicaid
HP264B2OtherHEALTH PARTNERS
080075726Medicare UPIN
MN5T131KLOtherBCBS OF MINNESOTA
MN102868C736OtherUCARE MINNESOTA