Provider Demographics
NPI:1679532022
Name:LAEDTKE, THOMAS WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:LAEDTKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:SUITE 180
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5845
Mailing Address - Country:US
Mailing Address - Phone:952-927-7810
Mailing Address - Fax:952-927-6309
Practice Address - Street 1:7701 YORK AVE S
Practice Address - Street 2:SUITE 180
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-927-7810
Practice Address - Fax:952-927-6309
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN35437207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3300001OtherMEDICA CHOICE
MN658775OtherAMERICAS PPO
MN52A92LAOtherBLUE CROSS BLUE SHIELD
MN106122OtherPATIENT CHOICE
MN0256006OtherSELECT CARE
MNHP22302OtherHEALTH PARTNERS
MN119367C626OtherUCARE
MN3300003OtherMEDICA PRIMARY
MN960541013563OtherPREFERRED ONE
MN410999025OtherTRICARE
MN894720100Medicaid
MN52A92LAOtherBLUE CROSS BLUE SHIELD
MN3300003OtherMEDICA PRIMARY
MN658775OtherAMERICAS PPO