Provider Demographics
NPI:1891789053
Name:SPERDUTO, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:SPERDUTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6950 FRANCE AVE S
Mailing Address - Street 2:# 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2008
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:490 S MAPLE ST
Practice Address - Street 2:# 117
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1760
Practice Address - Country:US
Practice Address - Phone:952-442-6000
Practice Address - Fax:952-442-6004
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN349572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32721200Medicaid
MN104527OtherPT CHOICE
MNHP14452OtherHEALTH PARTNERS
MN24-28410OtherMEDICA
MN100685OtherUCARE
MN24-00004OtherMEDICA PRIMARY
MN963071000190OtherPREFERRED ONE
MN25142OtherAMERICA'S PPO
MN2M662SPOtherBLUE CROOS/BLUE SHIELD
MN25142OtherAMERICA'S PPO