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Individual

MAGGIE BETH NEUDECKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
4570 CTY. HWY. 61, MOOSE LAKE, MN 55767-9401
(218) 485-4491
(218) 485-4724
Mailing address
4570 CTY. HWY. 61, MOOSE LAKE, MN 55767-9401
(218) 485-4491
(218) 485-4724

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
54207
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1154647071
BCBS OF MN
MN
01
1154647071
MEDICA
05
1154647071
MN
01
P00978476
RR MEDICARE
Enumeration date
04/16/2010
Last updated
01/13/2014
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