Healthcare Provider Details

I. General information

NPI: 1982517504
Provider Name (Legal Business Name): HIMANSHU S JOG MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

313 OAK ST SE
MINNEAPOLIS MN
55414-2926
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3590
  • Fax: 612-747-1280
Mailing address:
  • Phone: 612-863-3590
  • Fax: 612-863-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36441
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: