Provider Demographics
NPI:1457663601
Name:PADDOCK, MICHAEL THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:PADDOCK
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Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 1309 - 8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-3456
Mailing Address - Fax:651-254-5216
Practice Address - Street 1:640 JACKSON STREET
Practice Address - Street 2:MS11102F
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:651-254-5216
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2019-05-13
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Provider Licenses
StateLicense IDTaxonomies
IL036131957207P00000X
WI64249207P00000X
MN108311207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine