Healthcare Provider Details

I. General information

NPI: 1255398830
Provider Name (Legal Business Name): JASON JOHN WIRTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 SLOAN PLACE SUITE 200
ST PAUL MN
55117-2074
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 651-772-6235
  • Fax: 651-772-6261
Mailing address:
  • Phone: 612-262-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number44626
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: