Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 19761-2 | MN |
NPI | 1124183652 |
---|---|
Provider Name | James K Struve |
First Address | Bloomington, MN 55431-1200 |
Second Address | Bloomington, MN 55431-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 04/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
998378300 | (05) | MN |
A94035 | (02) | MN |