Basic Information
| Provider Information | |||||||||
| NPI: | 1780613075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EXCONDE | ||||||||
| FirstName: | RUPERT | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2828 CHICAGO AVE SOUTH | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128791000 | ||||||||
| FaxNumber: | 6128799116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2828 CHICAGO AVE SOUTH | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128791000 | ||||||||
| FaxNumber: | 6128799116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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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 | 2084N0400X | 40392 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | 40392 | MN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 142277 | 01 | MN | UCARE | OTHER | 1692244 | 01 | MN | ARAZ | OTHER | 1032021 | 01 | MN | PREFERRED ONE | OTHER | 269A4EX | 01 | MN | BCBS | OTHER | HP40306 | 01 | MN | HEALTHPARTNERS | OTHER | 05-00009 | 01 | MN | MEDICA PRIMARY | OTHER | 0551796 | 05 | IA | MEDICAID | 34202200 | 05 | WI | MEDICAID | 05-00250 | 01 | MN | MEDICA CHOICE | OTHER | 319337300 | 05 | MN | MEDICAID |