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General NPI Number Information
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NPI Number | 1265496343
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Entity Type | Individual
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Provider Name | WILLIAM FREDERIC NORTHRUP III M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4770 WHITE BEAR PKWY LOWER LEVEL
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-3394
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Country | US
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Telephone | 651-653-1850
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Fax | 651-426-6439
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Provider Business Mailing Address
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Address Line | 4702 LAKEVIEW DR
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City | MINNEAPOLIS
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State | MN
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Zip | 55424-1520
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Country | US
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Telephone | 925-926-6913
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Fax | 651-426-6439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20586
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License Number State | MN
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