Basic Information
| Provider Information | |||||||||
| NPI: | 1588626360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDDOW | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | NOEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6401 UNIVERSITY AVE NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554324341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725710 | ||||||||
| FaxNumber: | 7635713008 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 OSBORNE RD NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632365000 | ||||||||
| FaxNumber: | 7632363524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 36466 | MN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 07F97BE | 01 | MN | BCBS OF MN | OTHER | HP19393 | 01 | MN | HEALTHPARTNERS | OTHER | 0413019 | 01 | MN | MEDICA | OTHER | 1011516 | 01 | MN | PREFERRED ONE | OTHER | 26691 | 01 | MN | AMERICA'S PPO | OTHER | 5356125 | 01 | MN | AETNA | OTHER | 861725200 | 05 | MN | MEDICAID | 115835 | 01 | MN | UCARE MN | OTHER |