Provider Demographics
NPI:1316026958
Name:OFSTEDAL, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:OFSTEDAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE STREET SE
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 ST SE
Practice Address - Street 2:PWB THIRD FLOOR, CLINIC 3A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN34655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-05765OtherMEDICA PRIMARY
MN40G27OFOtherBLUE CROSS BLUE SHIELD
MNHP11141OtherHEALTH PARTNERS
MN01-05765OtherMEDICA CHOICE
MN102662OtherUCARE
MN21219OtherARAZ
MN1000588OtherPREFERRED ONE
MN40G27OFOtherBLUE CROSS BLUE SHIELD