Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Mark T Destache, MD

Individual provider Anesthesiology Physician · NPI 1023129483

Dr. Mark T Destache, MD is an Anesthesiology in Saint Paul, Minnesota. Graduated from Indiana University School of Medicine in 1987, 39 years ago. Practices with Northwestern Medical Faculty Foundation, a 4,394-clinician group and accepts Medicare assignment. Licensed in Illinois and Minnesota.

Years since qualifying
39
Trained at
Indiana University School of Medicine
Licensed in
IL, MN
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone: (651) 735-0501
Fax: (651) 735-1870
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Anesthesiology Physician (primary) Taxonomy 207L00000X · Licence 34185 (MN)
Anesthesiology Physician Taxonomy 207L00000X · Licence 036159952 (IL)

Record details

NPI number1023129483
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 31, 2006
Last updated in NPPESAugust 2, 2022
Certification dateAugust 2, 2022
Mailing address8681 Eagle Point Blvd, Lake Elmo, MN 55042-8628

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyANESTHESIOLOGY
Medical schoolINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduated 1987 (39 years in practice)
Group practice Northwestern Medical Faculty Foundation — 4394 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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