Provider Demographics
NPI:1306046545
Name:DENISE FORTE-PATHROFF M.D., P.C.
Entity type:Organization
Organization Name:DENISE FORTE-PATHROFF M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTE-PATHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-224-9643
Mailing Address - Street 1:225 N 7TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4417
Mailing Address - Country:US
Mailing Address - Phone:701-224-9643
Mailing Address - Fax:701-323-2929
Practice Address - Street 1:225 N 7TH ST
Practice Address - Street 2:STE B
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4417
Practice Address - Country:US
Practice Address - Phone:701-224-9643
Practice Address - Fax:701-323-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND016453Medicaid
NDD2588Medicare UPIN