Healthcare Provider Details

I. General information

NPI: 1548158330
Provider Name (Legal Business Name): JAMES DISER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 W 6TH ST
DULUTH MN
55806-1412
US

IV. Provider business mailing address

2832 W 6TH ST
DULUTH MN
55806-1412
US

V. Phone/Fax

Practice location:
  • Phone: 218-390-5105
  • Fax:
Mailing address:
  • Phone: 218-390-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberBC793108
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: