Healthcare Provider Details

I. General information

NPI: 1356379721
Provider Name (Legal Business Name): JOHN RICHARD COLLINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTH AVE
NORTHFIELD MN
55057-1498
US

IV. Provider business mailing address

8170 OLD CARRIAGE CT STE 100
SHAKOPEE MN
55379-3164
US

V. Phone/Fax

Practice location:
  • Phone: 507-646-1000
  • Fax:
Mailing address:
  • Phone: 952-428-3600
  • Fax: 952-428-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46339
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME154136
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME154136
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46339
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: