Individual
SUSAN ASHLIE DOORENBOS BUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 883-1000
Mailing address
8170 33RD AVE S, PO BOX 1309 MAIL STOP 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9644
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413399400
—
MN
Enumeration date
04/03/2006
Last updated
03/31/2016
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