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NPI Code Detail

MEDICARE: JULIE C. REDDAN M.D.

MEDICARE: JULIE C. REDDAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician41710MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11011352OTHERMNMEDICA CHOICE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3855113OTHERMNAMERICA'S PPO
41000010OTHERMNMEDICA PRIMARY
583D52REOTHERMNBLUE CROSS
6123761OTHERMNUCARE
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
81022115OTHERMNPREFERREDONE

General Provider Information

NPI Number : 1366444366
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE C. REDDAN M.D.
Provider Business Mailing Address
First Line : 2211 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3711
Country : US
Telephone Number : 612-813-3863
Fax Number :
Provider Business Practice Location Address
First Line : 701 DELLWOOD ST S
Second Line :
City : CAMBRIDGE
State : MN
Zip : 55008-1920
Country : US
Telephone Number : 763-689-8700
Fax Number : 763-688-7941
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 01/23/2023

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