Provider Demographics
NPI:1265496343
Name:NORTHRUP, WILLIAM FREDERIC III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERIC
Last Name:NORTHRUP
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:4702 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1520
Mailing Address - Country:US
Mailing Address - Phone:925-926-6913
Mailing Address - Fax:651-426-6439
Practice Address - Street 1:4770 WHITE BEAR PKWY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3394
Practice Address - Country:US
Practice Address - Phone:651-653-1850
Practice Address - Fax:651-426-6439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN20586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN18-00157OtherMEDICA
MN108709OtherUCARE
MN109263OtherHEALTHPARTNERS
MN536K0NOOtherBLUE CROSS BLUE SHIELD MN
MN202741675 55110 A001OtherTRICARE
MNA57110010519OtherPREFERRED ONE
MN202741675 55110 A001OtherTRICARE