Basic Information
| Provider Information | |||||||||
| NPI: | 1598727638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CODY | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122625000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 OSBORNE RD NE STE 255 | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632362500 | ||||||||
| FaxNumber: | 7632362505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 30742 | MN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | HP13072 | 01 | MN | HEALTHPARTNERS | OTHER | 133890100 | 05 | MN | MEDICAID | 1728229 | 01 | MN | MEDICA | OTHER | 24970 | 01 | MN | AMERICA'S PPO | OTHER | 0817023 | 01 | MN | PREFERRED ONE | OTHER | 08F09CO | 01 | MN | BCBS OF MN | OTHER | 107284 | 01 | MN | UCARE MN | OTHER | 4133301 | 01 | MN | AETNA | OTHER |