Provider Demographics
NPI:1699765206
Name:DOBERSTEIN, ANN (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:DOBERSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 LOBERG AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2652
Mailing Address - Country:US
Mailing Address - Phone:218-249-5700
Mailing Address - Fax:218-249-4666
Practice Address - Street 1:508 UPLAND ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8026
Practice Address - Country:US
Practice Address - Phone:907-335-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C013OtherTRICARE WEST
CN1041016555OtherPREFERRED ONE
MN90D75DOOtherBCBSMN
MN174268000Medicaid
WI33335700Medicaid
01-04590OtherMEDICA
111180P498OtherUCARE
HP26561OtherHEALTHPARTNERS
AK1749184Medicaid
01-04590OtherMEDICA
080158262Medicare ID - Type UnspecifiedRAILROAD