Provider Demographics
NPI:1649237967
Name:HUSEBYE, DAVID GUNNAR (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GUNNAR
Last Name:HUSEBYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SHERMAN ST.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-772-6251
Mailing Address - Fax:651-224-9661
Practice Address - Street 1:360 SHERMAN ST.
Practice Address - Street 2:SUITE 250
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-772-6251
Practice Address - Fax:651-224-9661
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN27878207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN908767200Medicaid
B58566Medicare UPIN
MN908767200Medicaid