IndividualActive
Madeline Detra
NPI 1992634885 · General Practice Physician · Anoka, MN
Provider details
- NPI number
- 1992634885
- Entity type
- Individual
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Sex
- Female
- Sole proprietor
- No
- License
- 1346244274 (MN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2621 Greenhaven Rd
Anoka, MN 55303-5566
Phone: (763) 421-5540
Approximate (ZIP-level) locationGet directions
Mailing address
2621 Greenhaven Rd
Anoka, MN 55303-5566
Registry dates
- Enumerated
- 2026-05-16
- Last updated
- 2026-05-16
- Certified
- 2026-05-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.