Basic Information
| Provider Information | |||||||||
| NPI: | 1669579975 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MARETTE | ||||||||
| FirstName: | SHELLY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE STREET SE, MMC 292 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HARVARD ST SE | ||||||||
| Address2: | UNIT J2-300 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 48175 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0147160 | 05 | MT | MEDICAID | 0596767 | 05 | IA | MEDICAID | B681 | 01 | MN | CHAMPUS | OTHER | 1044925 | 01 | MN | PREFERRED ONE | OTHER | 16-02032 | 01 | MN | MEDICA PRIMARY | OTHER | HP55471 | 01 | MN | HEALTH PARTNERS | OTHER | 504K5MA | 01 | MN | BCBS | OTHER | 34696100 | 05 | WI | MEDICAID | 135210 | 01 | MN | UCARE | OTHER | 718615100 | 05 | MN | MEDICAID | 16-03686 | 01 | MN | MEDICA CHOICE | OTHER | 2380614 | 01 | MN | ARAZ | OTHER |