Healthcare Provider Details

I. General information

NPI: 1639100282
Provider Name (Legal Business Name): JAMES P KEARIN PA -C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CHICAGO AVE SUITE 402
MINNEAPOLIS MN
55407-1318
US

IV. Provider business mailing address

3001 METRO DR SUITE 330
BLOOMINGTON MN
55425-4506
US

V. Phone/Fax

Practice location:
  • Phone: 952-814-6600
  • Fax:
Mailing address:
  • Phone: 952-814-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number8930
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: