Provider Demographics
NPI:1194766774
Name:TUDOR, MARIA DANA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DANA
Last Name:TUDOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:480 OSBORNE RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2773
Mailing Address - Country:US
Mailing Address - Phone:763-785-4500
Mailing Address - Fax:763-785-3329
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-785-4500
Practice Address - Fax:763-785-3329
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0428724207R00000X
IA36874207R00000X
MN57926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025457800Medicaid
IA0741371Medicaid
P00360039OtherMEDICARE RAILROAD
32839OtherWELLMARK BCBS OF IA
229867OtherMIDLANDS
H32361Medicare UPIN
IA0741371Medicaid