Provider Demographics
NPI:1730297987
Name:AMBERG, JOSEPH PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:AMBERG
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1690 UNIVERSITY AVE W
Mailing Address - Street 2:STE 570
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3741
Mailing Address - Country:US
Mailing Address - Phone:651-232-4800
Mailing Address - Fax:651-232-4899
Practice Address - Street 1:1690 UNIVERSITY AVE W
Practice Address - Street 2:STE 570
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3741
Practice Address - Country:US
Practice Address - Phone:651-232-4800
Practice Address - Fax:651-232-4899
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN30394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30746400Medicaid
MN803582200Medicaid
MN803582200Medicaid
MN110009487Medicare ID - Type Unspecified