Provider Demographics
NPI:1538128814
Name:IDE, ARTHUR W III (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:W
Last Name:IDE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 FRANCE AVE SO
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4544
Mailing Address - Country:US
Mailing Address - Phone:952-374-5995
Mailing Address - Fax:952-374-5997
Practice Address - Street 1:7300 FRANCE AVE SO
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4544
Practice Address - Country:US
Practice Address - Phone:952-374-5995
Practice Address - Fax:952-374-5997
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32318207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN893565300Medicaid
MND81114Medicare UPIN
MN070000221Medicare ID - Type Unspecified