1578525465 NPI number — WILLIAM L CLAPP MD

Table of content: WILLIAM L CLAPP MD (NPI 1578525465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578525465 NPI number — WILLIAM L CLAPP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAPP
Provider First Name:
WILLIAM
Provider Middle Name:
L
Provider Name Prefix Text:
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:
1578525465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5346 LYNDALE AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55419-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-746-5888
Provider Business Mailing Address Fax Number:
612-746-5818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5346 LYNDALE AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55419-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-746-5888
Provider Business Practice Location Address Fax Number:
612-746-5818
Provider Enumeration Date:
04/05/2006

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: 2084P0800X , with the licence number:  39313 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HP22348 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260044492 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115611 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 551220400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62G47CL . This is a "BLUECROSS BLUESHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 62G46CL . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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