MR. ANTHONY KEVIN MUIDERMAN MD NPI 1003802430

Plastic Surgery in Grand Forks, ND

Individual Male Plastic Surgery PECOS Enrolled Accepts Medicare Years Experience 30

About ANTHONY MUIDERMAN

Anthony Muiderman is a provider established in Grand Forks, North Dakota and his medical specialization is plastic surgery with more than 30 years of experience. The NPI number of Anthony Muiderman is 1003802430 and was assigned on September 2005. The practitioner's primary taxonomy code is 208200000X with license number 10458 (ND). The provider is registered as an individual and his NPI record was last updated February 2019. Anthony Muiderman is enrolled in PECOS and registered with Medicare accepting claims assignment.

NPI

1003802430

Provider NameMR. ANTHONY KEVIN MUIDERMAN MD
Provider Location Address3165 DEMERS AVE - TRUYU AESTHETIC CENTER GRAND FORKS, ND 58201
Provider Mailing Address2401 DEMERS AVE GRAND FORKS, ND 58201
GenderMale
NPI Entity TypeIndividual
Medical School NameWAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year1990
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date09-21-2005
Last Update Date02-26-2019

Primary Taxonomy

Taxonomy Code208200000X
ClassificationPlastic Surgery
TypeAllopathic & Osteopathic Physicians
License No.10458
License StateND
Taxonomy DescriptionA plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Business Address

MR. ANTHONY KEVIN MUIDERMAN MD
3165 DEMERS AVE - TRUYU AESTHETIC CENTER
GRAND FORKS, ND
ZIP 58201
Phone: (701) 780-6623

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Mailing Address

MR. ANTHONY KEVIN MUIDERMAN MD
2401 DEMERS AVE
GRAND FORKS, ND
ZIP 58201
Phone: (701) 780-1891
Fax: (701) 780-1942

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
34199500MEDICAID (05)WI

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1427204346MRS. AMY LYNN KNUTSON SHIMEK FNP-C
Individual
Nurse Practitioner (Primary Care)3165 DEMERS AVE - TRUYU AESTHETIC CENTER
GRAND FORKS, ND 58201
(701) 780-6623
1659525640 JARON HUDSON MCMULLIN MD
Individual
Plastic Surgery3165 DEMERS AVE - TRUYU AESTHETIC CENTER
GRAND FORKS, ND 58201
(701) 780-6623

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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