Provider Demographics
NPI:1427068618
Name:AMATRUDA, THOMAS T III (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:T
Last Name:AMATRUDA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:480 OSBORNE RD NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2866
Mailing Address - Country:US
Mailing Address - Phone:763-786-1620
Mailing Address - Fax:763-780-3099
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:SUITE 220
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2866
Practice Address - Country:US
Practice Address - Phone:763-786-1620
Practice Address - Fax:763-780-3099
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN35894207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410729979OtherCOMMERCIAL
MN46Q06AMOtherBLUE SHIELD
MN102713OtherUCARE
MN01009364OtherPREFERRED ONE
MN661585600Medicaid
MNHP22180OtherHEALTH PARTNERS
MN3607502OtherMEDICA
MN3607502OtherSELECT CARE
MN3607502OtherSELECT CARE
MN830000186Medicare ID - Type UnspecifiedMEDICARE