Healthcare Provider Details

I. General information

NPI: 1427068618
Provider Name (Legal Business Name): THOMAS T AMATRUDA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 OSBORNE RD NE SUITE 220
FRIDLEY MN
55432-2866
US

IV. Provider business mailing address

480 OSBORNE RD NE SUITE 220
FRIDLEY MN
55432-2866
US

V. Phone/Fax

Practice location:
  • Phone: 763-786-1620
  • Fax: 763-780-3099
Mailing address:
  • Phone: 763-786-1620
  • Fax: 763-780-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35894
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: