Provider Demographics
NPI:1740250216
Name:SUDDUTH, DAVID LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LLOYD
Last Name:SUDDUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:480 OSBORNE RD NE STE AND200
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-236-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329912084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1507725OtherUBH
1012793OtherPREFERRED ONE
1507725OtherMEDICA
260032841OtherRR MEDICARE
MN275207700Medicaid
596821OtherARAZ
596821OtherAMERICAS PPO
259466OtherPRONET
108461OtherUCARE
33A45SUOtherBCBS
1507725OtherUBH
33A45SUOtherBCBS
596821OtherAMERICAS PPO