MR. ANTHONY KEVIN MUIDERMAN (NPI# 1003802430) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003802430 |
| Entity Type | Individual |
| Full Name | MR. ANTHONY KEVIN MUIDERMAN |
| Credential | MD |
| Practice Address |
3165 Demers Ave - Truyu Aesthetic Center Grand Forks ND 58201 |
| Mailing Address |
2401 Demers Ave Grand Forks ND 58201 |
| Practice Telephone | 7017806623 |
| Mailing Telephone | 7017801891 |
| Mailing Fax Number | 7017801942 |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2019-02-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 10458 | ND | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34199500 | 05 |
| Street Address |
3165 DEMERS AVE - TRUYU AESTHETIC CENTER |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659525640 | Jaron Hudson Mcmullin | Plastic Surgery | 3165 Demers Ave - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2008-11-04 |
| 1427204346 | Amy Lynn Knutson Shimek | Nurse Practitioner | 3165 Demers Ave - Truyu Aesthetic Center, Grand Forks, ND 58201-4049 | 2008-08-12 |
| 1225028699 | Kyle Matthew Rockers | Dermatology | 3165 Demers Ave - Truyu Aesthetic Center, Grand Forks, ND 58201-4049 | 2005-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629321856 | J L Crow Plastic Surgery Services | Plastic Surgery | 1191 South Columbia Road, Grand Forks, ND 58201-4033 | 2012-10-25 |
| 1659525640 | Jaron Hudson Mcmullin | Plastic Surgery | 3165 Demers Ave - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2008-11-04 |
| 1932275088 | Noren Bradly Meland | Plastic Surgery | 4440 S Washington St - Altru Professional Center, Grand Forks, ND 58201 | 2006-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396184859 | Nicholas Steven Adams | Plastic Surgery | 4450 31st Ave S, Ste 102, Fargo, ND 58104-4557 | 2013-06-18 |
| 1558448712 | Donald Richard Lamb | Plastic Surgery | 1507 South University Drive, Fargo, ND 58103 | 2006-11-01 |
| 1457353690 | Ahmed Abdullah | Plastic Surgery | 3280 20th St S, Fargo, ND 58104-5917 | 2005-06-01 |
| 1265065668 | Center for Plastic Surgery | Plastic Surgery | 4450 31st Ave S Ste 102, Fargo, ND 58104-4557 | 2020-02-14 |
| 1659620110 | Fargo Plastic Surgery PC | Plastic Surgery | 3280 20th St S, Fargo, ND 58104-5917 | 2012-08-30 |
| 1124280649 | Theresa Anne Hegge | Plastic Surgery | 222 N 7th St, Bismarck, ND 58501-4436 | 2008-06-26 |
| 1811166325 | Ricky Becker Md PC | Plastic Surgery | 1500 Interchange Ave, Ste 100, Bismarck, ND 58501-2079 | 2008-02-28 |
| 1720131451 | Steven Gary Yearsley | Plastic Surgery | 401 N 9th St, Bismarck, ND 58501-4530 | 2007-01-18 |
| 1841357399 | Charles I Benjamin Md PC | Plastic Surgery | 3280 20th St S, Fargo, ND 58104-5917 | 2007-01-03 |
| 1396802757 | William Yvorchuk Mdcm | Plastic Surgery | 3270 20th St S, Fargo, ND 58104-5917 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.