Provider Demographics
NPI:1013004175
Name:MIDWEST PLASTIC SURGERY, P.A.
Entity Type:Organization
Organization Name:MIDWEST PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:952-920-2600
Mailing Address - Street 1:6545 FRANCE AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2120
Mailing Address - Country:US
Mailing Address - Phone:952-920-2600
Mailing Address - Fax:952-920-2668
Practice Address - Street 1:6545 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2120
Practice Address - Country:US
Practice Address - Phone:952-920-2600
Practice Address - Fax:952-920-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1389208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN579013100Medicaid
ND18029Medicaid
MN25685OtherHEALTH PARTNERS
MN2M749ADOtherBLUE CROSS/BLUE SHIELD
MN221070615OtherMETROPOLITAN HEALTH PLAN
MNC721OtherU-CARE
ND18029Medicaid
MN221070615OtherMETROPOLITAN HEALTH PLAN