Provider Demographics
NPI:1992800205
Name:PENA, FERNANDO A (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 DELAWARE STREET SE, MMC 292
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-9400
Mailing Address - Fax:
Practice Address - Street 1:2512 S 7TH ST
Practice Address - Street 2:FIRST FLOOR, R-102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1404
Practice Address - Country:US
Practice Address - Phone:612-273-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN46397207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110A6DAOtherBLUE CROSS BLUE SHIELD
MN241962900Medicaid
MNHP40413OtherHEALTHPARTNERS
MT0068306Medicaid
MN131110OtherPREFERRED ONE
MN09-01315OtherMEDICA CHOICE
MN2033406OtherARAZ
MN134106OtherFAIRVIEW
MN09-00027OtherMEDICA PRIMARY