Provider Demographics
NPI:1457385346
Name:MINNESOTA ORTHOPEDICS PA
Entity Type:Organization
Organization Name:MINNESOTA ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CEDERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-952-2388
Mailing Address - Street 1:6490 EXCELSIOR BLVD
Mailing Address - Street 2:STE 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:952-925-0743
Practice Address - Street 1:6490 EXCELSIOR BLVD
Practice Address - Street 2:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3D553MIOtherBLUE CROSS BLUE SHIELD
0R0607OtherPREFERRED ONE CORPORATE
C06571Medicare ID - Type UnspecifiedCORPORATE