Healthcare Provider Details

I. General information

NPI: 1881036143
Provider Name (Legal Business Name): JOSHUA JAMES HOHERTZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E 26TH ST SUITE 600
MINNEAPOLIS MN
55404-4515
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 612-775-6200
  • Fax: 612-775-6222
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11486
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: