Provider Demographics
NPI:1679506604
Name:SPAETH, JOSEPH H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:H
Last Name:SPAETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:JOSEPH
Other - Last Name:SPAETH
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:H JOSEPH SPAETH, MD
Mailing Address - Street 1:2355 HIGHWAY 36 W STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3905
Mailing Address - Country:US
Mailing Address - Phone:651-292-2013
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 W STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3905
Practice Address - Country:US
Practice Address - Phone:651-292-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN405192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN488023400Medicaid