Provider Demographics
NPI:1154369866
Name:MADELINE GARTNER SURGERY PLLC
Entity type:Organization
Organization Name:MADELINE GARTNER SURGERY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:HALLIE
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-473-1480
Mailing Address - Street 1:2805 CAMPUS DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2676
Mailing Address - Country:US
Mailing Address - Phone:763-473-1480
Mailing Address - Fax:763-473-1998
Practice Address - Street 1:2805 CAMPUS DR
Practice Address - Street 2:SUITE 405
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:763-473-1480
Practice Address - Fax:763-473-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN86G16MAOtherBLUECROSS
MN116634OtherHEALTHPARTNERS
MN131146OtherUCARE
MNC04299Medicare PIN