Active NPI
Susan M Martodam, LRD
- Registered Dietitian
- Detroit Lakes, MN
National Provider Identifier
1073531646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2223
- Practice address
- 1245 Washington Ave
Detroit Lakes, MN 56501-3905 - Phone
- (218) 846-2000
- Fax
- (701) 234-2045
- NPI assigned
- Jul 18, 2006
- Last updated
- Sep 16, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2223 | MN | Primary |
Addresses
Primary practice location
1245 Washington Ave
Detroit Lakes, MN 56501-3905
Mailing address
1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone (218) 846-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2223 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221523200000",
"number": "1073531646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 WASHINGTON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013905",
"telephone_number": "218-846-2000",
"fax_number": "701-234-2045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 WASHINGTON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013905",
"telephone_number": "218-846-2000",
"fax_number": "701-234-2045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTODAM",
"first_name": "SUSAN",
"middle_name": "M",
"credential": "LRD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2008-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.