Provider Demographics
NPI:1194746313
Name:STATTON, MARIA K (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:K
Last Name:STATTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1233 34TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5112
Mailing Address - Country:US
Mailing Address - Phone:218-333-5180
Mailing Address - Fax:218-759-5438
Practice Address - Street 1:1233 34TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5112
Practice Address - Country:US
Practice Address - Phone:218-333-5180
Practice Address - Fax:218-759-5438
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN960315800Medicaid
MN080005882Medicare PIN
MN960315800Medicaid