1194189753 NPI number — MICHAEL JAEGER

Table of content: MICHAEL JAEGER (NPI 1194189753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194189753 NPI number — MICHAEL JAEGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAEGER
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194189753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 PARK AVE
Provider Second Line Business Mailing Address:
HENNEPIN COUNTY MEDICAL CENTER, INTERNAL MEDICINE
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-873-2702
Provider Business Mailing Address Fax Number:
612-904-4577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FODEN RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-828-1122
Provider Business Practice Location Address Fax Number:
207-828-0188
Provider Enumeration Date:
04/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MD25838 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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