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NPI Code Detail

MEDICARE: DR. SAMUEL W SPEARS M.D.

MEDICARE: DR. SAMUEL W SPEARS 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
1207R00000XInternal Medicine Physician43575MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
241F89SPOTHERMNBCBS MINNESOTA
30402997OTHERMNMEDICA HEALTH PLAN

General Provider Information

NPI Number : 1689670150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL W SPEARS M.D.
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 407 W 66TH ST
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2304
Country : US
Telephone Number : 612-798-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 11/09/2020

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