Provider Demographics
NPI:1083661680
Name:IDELKOPE, BRUCE IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:IRA
Last Name:IDELKOPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2109
Mailing Address - Country:US
Mailing Address - Phone:952-920-7200
Mailing Address - Fax:763-302-4234
Practice Address - Street 1:3400 W 66TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2109
Practice Address - Country:US
Practice Address - Phone:952-920-7200
Practice Address - Fax:763-302-4234
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN130005771OtherRAILROAD MEDICARE
MN30203900Medicaid
MN489092200Medicaid
MN0265008OtherPREFERRED ONE
MN100288C029OtherUCARE
MNHP13585OtherHEALTHPARTNERS
MN25828OtherAMERICA'S PPO
MN0501641OtherMEDICA
MN07620IDOtherBCBS OF MN
MN100288C029OtherUCARE
MN130005771OtherRAILROAD MEDICARE