Basic Information
Provider Information | |||||||||
NPI: | 1134152218 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HORDINSKY | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | KRAMARCZUK | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 720 WASHINGTON AVE SE, STE 200 | ||||||||
Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 55414 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6128840649 | ||||||||
FaxNumber: | 6126727422 | ||||||||
Practice Location | |||||||||
Address1: | 516 DELAWARE STREET SE, CLINIC 5A | ||||||||
Address2: | DERMATOLOGY CLINIC | ||||||||
City: | MINNEAPOLIS | ||||||||
State: | MN | ||||||||
PostalCode: | 554550356 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6126255656 | ||||||||
FaxNumber: | 6126727422 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/09/2006 | ||||||||
LastUpdateDate: | 01/28/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 25675 | MN | Y |   | Allopathic & Osteopathic Physicians | Dermatology |   |
ID Information
ID | Type | State | Issuer | Description | 1009142 | 01 | MN | PREFERRED ONE | OTHER | HP22110 | 01 | MN | HEALTHPARTNERS | OTHER | 768160 | 01 | MN | ARAZ | OTHER | 100327 | 01 | MN | UCARE | OTHER | 03-24884 | 01 | MN | MEDICA CHOICE | OTHER | 179598800 | 05 | MN |   | MEDICAID | 03-00010 | 01 | MN | MEDICA PRIMARY | OTHER | 2T240HD | 01 | MN | BCBS | OTHER |