Madeline Nicole Detra, is a
General Practice physician based in Anoka, Minnesota. Madeline Nicole Detra is licensed to practice in Minnesota (license number 1346244274) and her current practice location is 2621 Greenhaven Rd, Anoka, Minnesota. She can be reached at her office (for appointments etc.) via phone at
(763) 421-5540.
NPI number for Madeline Nicole Detra is 1992634885 and her current mailing address is 2621 Greenhaven Rd, Anoka, Minnesota. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1992634885.
Physician's Profile
| Full Name | Madeline Nicole Detra |
|---|
| Gender | Female |
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| Speciality | General Practice |
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| Location | 2621 Greenhaven Rd, Anoka, Minnesota |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1992634885
- Provider Enumeration Date: 05/16/2026
- Last Update Date: 05/16/2026
Medical Identifiers
Medical identifiers for Madeline Nicole Detra such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1992634885 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 208D00000X | General Practice | 1346244274 (Minnesota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Madeline Nicole Detra is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Madeline Nicole Detra, 2621 Greenhaven Rd, Anoka, MN 55303-5566 Ph: (763) 421-5540 | Madeline Nicole Detra, 2621 Greenhaven Rd, Anoka, MN 55303-5566 Ph: (763) 421-5540 |
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