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General NPI Number Information
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NPI Number | 1568575173
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Entity Type | Individual
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Provider Name | SAMUEL CALVERT DUDLEY JR. M.D., PH.D
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 2450 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1450
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Country | US
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Telephone | 612-672-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 420 DELAWARE STREET SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-624-8970
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Fax | 612-626-4411
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 336.080316
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 044910
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD14147
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License Number State | RI
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