Healthcare Provider Details

I. General information

NPI: 1881608917
Provider Name (Legal Business Name): JOHN C HULBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 FRANCE AVE S SUITE 500
EDINA MN
55435-2129
US

IV. Provider business mailing address

6363 FRANCE AVE S SUITE 500
EDINA MN
55435-2129
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-7660
  • Fax: 952-920-2049
Mailing address:
  • Phone: 952-920-7660
  • Fax: 952-920-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number28070
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: