Provider Demographics
NPI:1417060401
Name:OSEID, JEFFREY WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WADE
Last Name:OSEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3955 PARKLAWN AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5655
Mailing Address - Country:US
Mailing Address - Phone:952-831-1944
Mailing Address - Fax:952-278-6947
Practice Address - Street 1:501 E NICOLLET BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6732
Practice Address - Country:US
Practice Address - Phone:952-831-1944
Practice Address - Fax:952-278-6947
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN33615208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN40897OSOtherBC/BS
MN1219472OtherMEDICA
MNFP9020802019OtherPREFERRED ONE
MN1219472OtherMEDICA