Provider Demographics
NPI:1336187772
Name:CEDERBERG, PAUL ALLEN (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALLEN
Last Name:CEDERBERG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6490 EXCELSIOR BOULEVARD
Mailing Address - Street 2:SUITE W417 MEADOWBROOK MEDICAL BUILDING
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4705
Mailing Address - Country:US
Mailing Address - Phone:952-925-2388
Mailing Address - Fax:952-924-0743
Practice Address - Street 1:6490 EXCELSIOR BOULEVARD
Practice Address - Street 2:SUITE W417 MEADOWBROOK MEDICAL BUILDING
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4705
Practice Address - Country:US
Practice Address - Phone:952-925-2388
Practice Address - Fax:952-925-0743
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN24260207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0925946OtherMEDICA
MN3D613CEOtherBLUE CROSS BLUE SHIELD
924850118001OtherPREFERRED ONE
MN0925946OtherMEDICA