MEDICARE: JAMES R EELKEMA 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	207Q00000X	Family Medicine Physician	26056	MN

General Provider Information

NPI Number	:	1962404376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R EELKEMA MD

Provider Business Mailing Address
First Line	:	7801 E BUSH LAKE RD
Second Line	:	STE 300
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439-3120
Country	:	US
Telephone Number	:	952-985-8911
Fax Number	:	952-985-8999

Provider Business Practice Location Address
First Line	:	4102 EGAN DR
Second Line	:
City	:	SAVAGE
State	:	MN
Zip	:	55378-2023
Country	:	US
Telephone Number	:	952-985-8700
Fax Number	:	952-985-8700

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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