Milo Wilder Due, PSYD LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP7115 Issued in MN

Practice address

2101 Minnehaha Ave
Minneapolis, MN 55404-3107

Phone

(612) 721-1204

Fax

(612) 721-9850

NPI assigned

Nov 18, 2024

Sex

Unspecified or another gender identity

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Indian Health Board of Minneapolis, Inc

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1811999162

  MN

  Medicare reassignment NPD
• Indian Health Board of Minneapolis, Inc

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1760949168
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1093530883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 ELLIOT AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072636",
            "telephone_number": "612-968-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 MINNEHAHA AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043107",
            "telephone_number": "612-721-1204",
            "fax_number": "612-721-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUE",
        "first_name": "MILO",
        "middle_name": "WILDER",
        "name_prefix": "Dr.",
        "credential": "PSYD LP",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP7115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Dudek
• Rebecca Duden
• Christine Dudero, MA, LMFT
• Crystal Marie Dudley, ATC
• Samuel Calvert Dudley Jr., M.D., PH.D
• Bernadette Kathryn Duellman
• Megan Duellman, FNP-C
• Julisa A Duenas, PH.D.
• Lindsay J Duenow
• Ha Phuong Ngoc Dufek, LPCC, LADC

• All providers in Minneapolis, MN
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.