Provider Demographics
NPI:1659464451
Name:MCLINN, DUDLEY MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:DUDLEY
Middle Name:MAURICE
Last Name:MCLINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 28TH STREET
Mailing Address - Street 2:SUITE 740
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1163
Mailing Address - Country:US
Mailing Address - Phone:612-870-7711
Mailing Address - Fax:612-870-1666
Practice Address - Street 1:920 E 28TH STREET
Practice Address - Street 2:SUITE 740
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1163
Practice Address - Country:US
Practice Address - Phone:612-870-7711
Practice Address - Fax:612-870-1666
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN024094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94584Medicare UPIN