MEDICARE: PAUL DAVID JANDL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	43175	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	99554JA	OTHER	MN	BCBS OF MN
2	15 75696	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1548248941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DAVID JANDL MD

Provider Business Mailing Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	STE 229N
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	651-645-3115
Fax Number	:	651-645-2752

Provider Business Practice Location Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	STE 229N
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	651-645-3115
Fax Number	:	651-645-2752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	07/08/2007

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Directions to “ PAUL DAVID JANDL MD” Practice Location

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