Basic Information
| Provider Information | |||||||||
| NPI: | 1053403980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUODIS | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | MMC 292 UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HARVARD ST SE | ||||||||
| Address2: | UNIT J2-300 UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 41300 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1021554 | 01 | MN | PREFERRED ONE | OTHER | 16-00398 | 01 | MN | MEDICA-CHOICE | OTHER | 0054009 | 05 | MT | MEDICAID | 16-02032 | 01 | MN | MEDICA-PRIMARY | OTHER | 930064 | 01 | ARAZ | OTHER | 59R93JU | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | HP38351 | 01 | MN | HEALTHPARTNERS | OTHER | 123469 | 01 | MN | U CARE | OTHER |