Provider Demographics
NPI:1275582876
Name:SPALDING, JOEL P (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:P
Last Name:SPALDING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2525 CHICAGO AVE
Mailing Address - Street 2:MAIL STOP 17-217
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4518
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7026
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:MAIL STOP 17-217
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6224
Practice Address - Fax:612-813-8263
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2016-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN41782084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN952818100Medicaid
MN260001629Medicare ID - Type Unspecified
MN952818100Medicaid