Provider Demographics
NPI:1386653947
Name:SPENCER, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-8693
Mailing Address - Country:US
Mailing Address - Phone:651-602-5312
Mailing Address - Fax:
Practice Address - Street 1:6363 FRANCE AVE S STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2142
Practice Address - Country:US
Practice Address - Phone:651-312-1700
Practice Address - Fax:952-920-4148
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN30322208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN306590100Medicaid
MNF23111Medicare UPIN
MN306590100Medicaid