Healthcare Provider Details

I. General information

NPI: 1225525710
Provider Name (Legal Business Name): JUAN JOSE CHANGO AZANZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-1100
  • Fax: 612-467-4102
Mailing address:
  • Phone: 612-467-1100
  • Fax: 612-467-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number79344
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: