Provider Demographics
NPI:1780613075
Name:EXCONDE, RUPERT E (MD)
Entity type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:E
Last Name:EXCONDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 MINNESOTA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5202
Mailing Address - Country:US
Mailing Address - Phone:612-879-1000
Mailing Address - Fax:612-879-9116
Practice Address - Street 1:3601 MINNESOTA DR STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5202
Practice Address - Country:US
Practice Address - Phone:612-879-1000
Practice Address - Fax:612-879-9116
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN403922084E0001X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN05-00009OtherMEDICA PRIMARY
MN142277OtherUCARE
MN1692244OtherARAZ
MN1032021OtherPREFERRED ONE
MN05-00250OtherMEDICA CHOICE
MNHP40306OtherHEALTHPARTNERS
MN319337300Medicaid
IA0551796Medicaid
MN269A4EXOtherBCBS
WI34202200Medicaid
MN142277OtherUCARE
MN1032021OtherPREFERRED ONE
MN130025718Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE