Provider Demographics
NPI:1386653947
Name:SPENCER, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3433 BROADWAY ST NE STE 115
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1759
Mailing Address - Country:US
Mailing Address - Phone:651-312-1500
Mailing Address - Fax:651-312-1570
Practice Address - Street 1:2800 CHICAGO AVE S
Practice Address - Street 2:300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1353
Practice Address - Country:US
Practice Address - Phone:651-225-7855
Practice Address - Fax:651-312-1570
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2018-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN30322208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN306590100Medicaid
MNF23111Medicare UPIN
MN306590100Medicaid