Provider Demographics
NPI:1780644047
Name:DOEDEN, BRADLEY M (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:DOEDEN
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 1:7701 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:55435-5845
Practice Address - Country:US
Practice Address - Phone:952-927-7810
Practice Address - Fax:952-927-6309
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP13175OtherHEALTH PARTNERS
MN0256006OtherSELECT CARE
MN20999OtherAMERICAS PPO
MN960540799002OtherPREFERRED ONE
MN410999025OtherTRICARE
MN107109C626OtherUCARE
MN3311337OtherMEDICA CHOICE
MN109127OtherPATIENT CHOICE
MN3300003OtherMEDICA PRIMARY
MN53966DOOtherBLUE CROSS BLUE SHIELD
MN616282700Medicaid
MN460000009Medicare ID - Type Unspecified
MN616282700Medicaid
A95919Medicare UPIN