Basic Information
| Provider Information | |||||||||
| NPI: | 1427068618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMATRUDA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 OSBORNE RD NE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637861620 | ||||||||
| FaxNumber: | 7637803099 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 OSBORNE RD NE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637861620 | ||||||||
| FaxNumber: | 7637803099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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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 | 207RH0003X | 35894 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 410729979 | 01 | MN | COMMERCIAL | OTHER | 46Q06AM | 01 | MN | BLUE SHIELD | OTHER | 102713 | 01 | MN | UCARE | OTHER | 01009364 | 01 | MN | PREFERRED ONE | OTHER | 661585600 | 05 | MN | MEDICAID | HP22180 | 01 | MN | HEALTH PARTNERS | OTHER | 3607502 | 01 | MN | MEDICA | OTHER | 3607502 | 01 | MN | SELECT CARE | OTHER |