Provider Demographics
NPI:1023190543
Name:MACOMBER, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:MACOMBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:420 DELAWARE STREET SE, MMC 741
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-884-0999
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE, CLINIC 3A
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN826567400Medicaid
04-02892OtherMEDICA CHOICE
IA0539502Medicaid
MN110A7MAOtherBLUE CROSS BLUE SHIELD
128141OtherUCARE
HP40352OtherHEALTHPARTNERS
1028590OtherPREFERREDONE
ND10387Medicaid
WI34069000Medicaid
04-00123OtherMEDICA PRIMARY
1353467OtherARAZ
SD7777470Medicaid
128141OtherUCARE
SD7777470Medicaid
MN826567400Medicaid