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General NPI Number Information
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NPI Number | 1710298336
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Entity Type | Individual
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Provider Name | SCOTT MARSHALL SCHMAEDEKE PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1155 FORD RD STE B
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-1115
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Country | US
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Telephone | 952-378-1800
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Fax | 952-378-1714
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Provider Business Mailing Address
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Address Line | 3100 W LAKE ST STE 210
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-4597
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Country | US
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Telephone | 612-925-6033
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Fax | 612-925-8496
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10816
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License Number State | MN
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