1568544096 NPI number — DR. MICHAEL A MADDAUS MD

Table of content: DR. MICHAEL A MADDAUS MD (NPI 1568544096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568544096 NPI number — DR. MICHAEL A MADDAUS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADDAUS
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568544096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE STREET SE, MMC 195
Provider Second Line Business Mailing Address:
UNIVERSITY OF MINNESOTA PHYSICIANS
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-626-6666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 HARVARD STREET SE, SUITE M100
Provider Second Line Business Practice Location Address:
UNIVERSITY OF MINNESOTA PHYSICIANS
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-625-5411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  28178 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208G00000X , with the licence number: 28178 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1977009 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2T098MA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 101564 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30648100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 768240 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1009223 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18-00066 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18-12353 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP22187 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".