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Individual

FREDERICK S MOSCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1055 WESTGATE DR, STE. 100, SAINT PAUL, MN 55114-1451
(612) 262-7800
Mailing address
3433 BROADWAY ST NE, STE 300, MINNEAPOLIS, MN 55413-1761
(763) 587-7737
(763) 587-7069

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45071
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0404654
MEDICA
05
101787000
MN
01
1031978
PREFERRED ONE
01
1671091
AMERICAS PPO
01
170843
UCARE MINNESOTA
01
220TIMO
BLUE CROSS BLUE SHIELD
05
34301100
WI
Enumeration date
10/20/2006
Last updated
11/10/2020
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