Healthcare Provider Details

I. General information

NPI: 1528163581
Provider Name (Legal Business Name): JAMES HERBERT HOUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1895 GLUEK LN
ROSEVILLE MN
55113-3829
US

V. Phone/Fax

Practice location:
  • Phone: 612-647-1750
  • Fax:
Mailing address:
  • Phone: 651-636-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number16585
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: