Provider Demographics
NPI:1700987906
Name:TUTTLE, TODD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE MMC 195
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-273-5700
Mailing Address - Fax:612-273-9675
Practice Address - Street 1:424 HARVARD ST SE
Practice Address - Street 2:MMC 195
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-273-5700
Practice Address - Fax:612-273-9675
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN392502086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN025A9TUOtherBLUE CROSS BLUE SHIELD
MN17-00869OtherMEDICA PRIMARY
MN1020726OtherPREFERRED ONE
MN114546OtherUCARE
MN1168373OtherARAZ
MNHP19413OtherHEALTH PARTNERS
MN17-00452OtherMEDICA CHOICE
MN246023800Medicaid
MN322016OtherFAIRVIEW
MN020001531Medicare ID - Type Unspecified
MN322016OtherFAIRVIEW