Individual
DR. MARLIEKE VAN TYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
233 GRAND AVE, PEDIATRIC AND YOUNG ADULT MEDICINE, PA, SAINT PAUL, MN 55102-2331
(651) 227-7806
(651) 256-6710
Mailing address
233 GRAND AVE, PEDIATRIC AND YOUNG ADULT MEDICINE, PA, SAINT PAUL, MN 55102-2331
(651) 227-7806
(651) 256-6710
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
42369
MN
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
42369
MN
208000000X
Pediatrics Physician
Primary
42369
MN
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
42369
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086670900
—
MN
05
—
34134900
—
WI
Enumeration date
11/01/2006
Last updated
05/06/2008
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