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Contact Information

MARLIEKE VAN TYN, MD
233 GRAND AVE
PEDIATRIC AND YOUNG ADULT MEDICINE, PA
SAINT PAUL, MN55102-2331
 Phone: 651-227-7806
 Fax: 651-256-6710
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
 

Pediatric Emergency Medicine

207PP0204X 93 Physician/Emergency Medicine
 

Pediatric Emergency Medicine

2080P0204X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MARLIEKE VAN TYN · (Female)

NPI Number 1487731527
Status Active
Credentials MD
Entity Individual
Enumeration date 11/01/2006
Last updated 05/06/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • MN License # 42369
  • MN Medicaid 086670900
  • WI Medicaid 34134900
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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