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NPI Code Detail

MEDICARE: JOHN MISA

MEDICARE: JOHN MISA
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
1207R00000XInternal Medicine Physician44461MN

General Provider Information

NPI Number : 1821075946
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MISA
Provider Business Mailing Address
First Line : 8170 33RD AVE S # MS 21110Q
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 205 WABASHA ST S
Second Line :
City : SAINT PAUL
State : MN
Zip : 55107-1805
Country : US
Telephone Number : 952-967-5584
Fax Number : 651-293-8232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 10/16/2024

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Directions to “ JOHN MISA ” Practice Location

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