Healthcare Provider Details

I. General information

NPI: 1275582876
Provider Name (Legal Business Name): JOEL P SPALDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE MAIL STOP 17-217
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVE MAIL STOP 17-217
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6224
  • Fax: 612-813-8263
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4178
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: