Marlieke Van Tyn, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

42369 Issued in MN

Practice address

233 Grand Ave
Pediatric and Young Adult Medicine, PA
Saint Paul, MN 55102-2331

Phone

(651) 227-7806

Fax

(651) 256-6710

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Dr. Marlieke Van Tyn Dahlberg Other name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Health Care

  • Pediatrics Physician
  • Minneapolis, MN
  • NPI 1932208808
  Medicare reassignment NPD
• Emergency Care Consultants, PA

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1669422788
  Medicare reassignment NPD
• Healtheast St. John'S Hospital

  dba Fairview St John's Hospital

  • General Acute Care Hospital
  • Maplewood, MN
  • NPI 1447218482
  Medicare reassignment NPD
• Healtheast Woodwinds Hospital

  dba Fairview Woodwinds Hospital

  • General Acute Care Hospital
  • Woodbury, MN
  • NPI 1356309322
  Medicare reassignment NPD
• Childrens Health Care

  • Children's Hospital
  • Minneapolis, MN
  • NPI 1881793750
  NPD
• Ecc Addiction & Toxicology Services LLC

  • Medical Toxicology (Emergency Medicine) Physician
  • Minneapolis, MN
  • NPI 1629532429
  NPD (past)
• Pediatric Surgical Associates LTD

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1093778292
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1487731527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 GRAND AVE",
            "address_2": "PEDIATRIC AND YOUNG ADULT MEDICINE, PA",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022331",
            "telephone_number": "651-227-7806",
            "fax_number": "651-256-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 GRAND AVE",
            "address_2": "PEDIATRIC AND YOUNG ADULT MEDICINE, PA",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022331",
            "telephone_number": "651-227-7806",
            "fax_number": "651-256-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN TYN",
        "first_name": "MARLIEKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "42369",
            "primary": false
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "MN",
            "license": "42369",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "42369",
            "primary": true
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MN",
            "license": "42369",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086670900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34134900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARLIEKE",
            "last_name": "DAHLBERG",
            "middle_name": "VAN TYN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sara Kay Van Dyk, OTR/L
• David Chan Yong Van Engen, PSYD
• Dirk J Van Oppen, M.D.
• Tessa Marie Van Overbeke, C.R.N.A.
• Bradley David Van Tassel
• Jason M Van Valkenburg, M.D.
• James S Van Vooren, MD
• Kathleen Van Zeeland
• Nancy Dawn Vanbeest, LMFT
• Johnna Ann Vanboxel, R.N.

• Pediatrics Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.