Provider Demographics
NPI:1336223866
Name:REDING, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:REDING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-625-1104
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 480
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-625-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37501207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN848430OtherARAZ
MN127256OtherUCARE
MN182278100Medicaid
MN36-00013OtherMEDICA PRIMARY
MN36-00070OtherMEDICA CHOICE
MNHP29191OtherHEALTH PARTNERS
MN1020249OtherPREFERRED ONE
MN43R98REOtherBLUE CROSS BLUE SHIELD
MN43R98REOtherBLUE CROSS BLUE SHIELD