Russell G Smidt, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

38657 Issued in MN

Practice address

1885 Plaza Dr
Park Nicollet Clinic - Eagan
Eagan, MN 55122-2612

Phone

(952) 993-4001

Fax

(952) 993-4075

NPI assigned

Dec 27, 2005

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1801873344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728",
            "telephone_number": "952-993-7169",
            "fax_number": "952-993-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 PLAZA DR",
            "address_2": "PARK NICOLLET CLINIC - EAGAN",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222612",
            "telephone_number": "952-993-4001",
            "fax_number": "952-993-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMIDT",
        "first_name": "RUSSELL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "38657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine L. Skagen, M.D.
• Mark Joseph Skala, DDS
• Jon David Skare, DDS
• Madeleine Gamble Slama, DDS, MS
• Jonah Sleweon
• Smile Design Family Dentistry
• Erin Smillie, OTRL
• Brittney Smith, PHARM.D.
• Casey C Smith, D.C.
• Christina Ashley Smith, RN

• Pediatrics Physician in Eagan, MN
• Providers in Eagan, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.