Basic Information
| Provider Information | |||||||||
| NPI: | 1851332399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUBMAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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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 | 2085N0700X | 26104 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 0247015 | 01 | MN | PREFERRED ONE | OTHER | 100721 | 01 | MN | UCARE | OTHER | 23691 | 01 | ND | BLUE CROSS BLUE SHIELD | OTHER | 299G2TU | 01 | MN | BLUE CROSS | OTHER | 290367900 | 05 | MN | MEDICAID | 300085304 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 23023 | 01 | MN | AMERICA'S PPO | OTHER | 31569000 | 05 | WI | MEDICAID | HP14582 | 01 | MN | HEALTHPARTNERS | OTHER | 1505370 | 05 | IA | MEDICAID | 18010TU | 01 | MN | BLUE CROSS | OTHER |