Provider Demographics
NPI:1174607436
Name:MAUER, SHELDON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:MICHAEL
Last Name:MAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE, MMC 491
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-672-7122
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE ST. SE, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-672-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19499208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0999615Medicaid
2T296MAOtherBLUE CROSS BLUE SHIELD
603744OtherARAZ
31-13334OtherMEDICA CHOICE
WI31330800Medicaid
MT0051701Medicaid
1010352OtherPREFERRED ONE
101067OtherUCARE
OH2104056Medicaid
31-72694OtherMEDICA PRIMARY
MN895080600Medicaid
CO91194993Medicaid
HP21993OtherHEALTH PARTNERS
603744OtherARAZ
CO91194993Medicaid