Provider Demographics
NPI:1720024409
Name:STUART, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:MAIL CODE G5
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1829
Mailing Address - Country:US
Mailing Address - Phone:612-873-7381
Mailing Address - Fax:612-904-4299
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:S1
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1829
Practice Address - Country:US
Practice Address - Phone:612-873-6800
Practice Address - Fax:612-904-4322
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN19242207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN652370600Medicaid
A95000Medicare UPIN
MN460000021Medicare ID - Type Unspecified