Provider Demographics
NPI:1528267382
Name:MAROLT, BARRY (DO)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:MAROLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2900
Mailing Address - Country:US
Mailing Address - Phone:763-581-3000
Mailing Address - Fax:763-581-3005
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2900
Practice Address - Country:US
Practice Address - Phone:763-581-3000
Practice Address - Fax:763-581-3005
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009648207R00000X
MN60348207R00000X
390200000X
IL036139636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty