Basic Information
Provider Information | |||||||||
NPI: | 1497723514 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DELAUNE | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1580 BEAM AVE | ||||||||
Address2: |   | ||||||||
City: | MAPLEWOOD | ||||||||
State: | MN | ||||||||
PostalCode: | 551091127 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6517797978 | ||||||||
FaxNumber: | 6517797656 | ||||||||
Practice Location | |||||||||
Address1: | 1580 BEAM AVE | ||||||||
Address2: |   | ||||||||
City: | MAPLEWOOD | ||||||||
State: | MN | ||||||||
PostalCode: | 551091127 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6517797978 | ||||||||
FaxNumber: | 6517797656 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2006 | ||||||||
LastUpdateDate: | 10/13/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 39955 | MN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 1012984 | 01 | MN | PREFERRED ONE | OTHER | 3600017 | 01 | MN | MEDICA | OTHER | 120217 | 01 | MN | UCARE MN | OTHER | 32335100 | 05 | WI |   | MEDICAID | HP22811 | 01 | MN | HEALTHPARTNERS | OTHER | 454410207 | 05 | IL |   | MEDICAID | 676089 | 01 | MN | AMERICA'S PPO | OTHER | 930025200 | 05 | MN |   | MEDICAID | 02R67DE | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER |