DR. RANDOLPH K. PETERSON (NPI# 1053380204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053380204 |
| Entity Type | Individual |
| Full Name | DR. RANDOLPH K. PETERSON |
| Credential | M.D. |
| Practice Address |
6525 France Ave S Suite 200 Edina MN 55435-2148 |
| Practice Telephone | 9529276501 |
| Practice Fax Number | 9526531435 |
| Mailing Telephone | 9529276501 |
| Mailing Fax Number | 9526531435 |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2015-11-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
40788 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PREFERRED ONE | 984811017049 | 01 |
| MN | HEALTHPARTNERS | HP31830 | 01 |
| MN | 881029000 | 05 | |
| MN | MEDICA | 11-00306 | 01 |
| MN | BLUE CROSS | 525S5PE | 01 |
| MN | RAILROAD MEDICARE | 220033481 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669461364 | Randolph E Peterson | Orthopaedic Surgery | 840 Sw 4th Ave, Ontario, OR 97914-2627 | 2005-10-17 |
| Street Address |
6525 FRANCE AVE S SUITE 200 |
| City | EDINA |
| State | MN |
| Zip Code | 55435-2148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558333781 | Martin Lee Immerman | Obstetrics & Gynecology | 6525 France Ave S, Paul Larson Ob Gyn Clinic Ste 100, Edina, MN 55435-3624 | 2006-02-02 |
| 1013383355 | Fairview Clinics | Obstetrics & Gynecology | 6525 France Ave S, Suite 100, Edina, MN 55435-2148 | 2015-08-20 |
| 1972987113 | Jessica Torres | Advanced Practice Midwife | 6525 France Ave S, Suite 100, Edina, MN 55435-2148 | 2015-07-17 |
| 1730592759 | Melissa Erber Kitzman | Nurse Practitioner | 6525 France Ave S, Suite 100, Edina, MN 55435-2148 | 2014-06-06 |
| 1730428582 | Evexia Rx, LLC | Pharmacy | 6525 France Ave S, Suite #100b, Edina, MN 55435-2148 | 2013-02-13 |
| 1972762631 | Reese Surgical Group Pllc | Surgery | 6525 France Ave S, Suite 305, Edina, MN 55435-2148 | 2008-06-06 |
| 1083888234 | Urology Associates, Ltd. | Urology | 6525 France Ave S, Suite 200, Edina, MN 55435-2148 | 2008-04-18 |
| 1023282266 | Urology Associates, Ltd. | Urology | 6525 France Ave S, Suite 200, Edina, MN 55435-2148 | 2008-04-18 |
| 1578772554 | Matthew Robert Braasch | Urology | 6525 France Ave S, Suite 200, Edina, MN 55435-2148 | 2007-05-22 |
| 1154450708 | Paul T Fadden | Urology | 6525 France Ave S, Suite 200, Edina, MN 55435-2148 | 2007-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
| Find all providers in zip 55435 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831627702 | Cade Dylan Arries | Pathology | 420 Delaware St Se # D142, Minneapolis, MN 55455-0341 | 2017-05-23 |
| 1013337773 | Kevin Jee Ha | Pathology | 172 6th St E Apt 1906, Saint Paul, MN 55101-1978 | 2014-04-22 |
| 1902238231 | Patrick Joseph Parks | Pathology | 2282 Field Stone Dr, Mendota Heights, MN 55120-1918 | 2013-08-09 |
| 1538505862 | Mary Louise Ulrickson | Pathology | 824 Westwood Dr S, Golden Valley, MN 55416-3355 | 2013-05-14 |
| 1386872620 | Ronald L Villella | Pathology | 13393 Danube Cir, Rosemount, MN 55068-3168 | 2009-06-25 |
| 1679791230 | Ann Marie Connor | Pathology | 1080 County Rd D W, Apt. 24, Roseville, MN 55126-3766 | 2007-04-20 |
| 1841349149 | Ken Julian Takekoshi | Pathology | 1766 Trail Rd, Mendota Heights, MN 55118-3730 | 2007-01-09 |
| 1669551693 | Martin L Lipschultz | Pathology | 716 Meadow Ln S, Minneapolis, MN 55416-3417 | 2006-11-02 |
| 1831281641 | Ajay Rawal | Pathology | 640 Jackson St - Mc 11103e, Hehealthpartners Regions Specialty Clinics, St. Paul, MN 55101-2502 | 2006-09-29 |
| 1639284870 | Michael Andrew Linden | Pathology | 420 Deleware St. Se, Mmc 609, Minneapolis, MN 55455 | 2006-08-20 |
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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.