Healthcare Provider Details

I. General information

NPI: 1093040735
Provider Name (Legal Business Name): ROBERT D JESKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MARTIN LUTHER KING DR
MANKATO MN
56001-6460
US

IV. Provider business mailing address

101 MARTIN LUTHER KING DR
MANKATO MN
56001-6460
US

V. Phone/Fax

Practice location:
  • Phone: 507-594-6500
  • Fax:
Mailing address:
  • Phone: 651-565-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55661
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: