Provider Demographics
NPI:1083618896
Name:NADEAU, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:NADEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 FRANCE AVE S
Mailing Address - Street 2:STE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4311
Mailing Address - Country:US
Mailing Address - Phone:952-806-0011
Mailing Address - Fax:952-806-9741
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:STE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4311
Practice Address - Country:US
Practice Address - Phone:952-806-0011
Practice Address - Fax:952-806-9741
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38275174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG27165Medicare UPIN