Provider Demographics
NPI:1972521748
Name:HOLMBERG, PETER DAVID (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DAVID
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:8290 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1847
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-08-01
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Provider Licenses
StateLicense IDTaxonomies
MN27603207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA93686Medicare UPIN
MNA93686Medicare UPIN
73B84HOOtherBLUE CROSS BLUE SHIELD
HP13534OtherHEALTHPARTNERS
901549OtherMEDICA