Provider Demographics
NPI:1699737791
Name:WALLACE-REED, RITA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:WALLACE-REED
Suffix:
Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:5701 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2467
Mailing Address - Country:US
Mailing Address - Phone:763-561-0344
Mailing Address - Fax:763-566-4658
Practice Address - Street 1:5701 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2467
Practice Address - Country:US
Practice Address - Phone:763-566-0344
Practice Address - Fax:763-566-4658
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2016-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN444082083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN312479700Medicaid
370002453Medicare ID - Type Unspecified
MN312479700Medicaid