Healthcare Provider Details

I. General information

NPI: 1497834261
Provider Name (Legal Business Name): JEFFREY A INDRELIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 FAXON RD N
NORWOOD MN
55368-9507
US

IV. Provider business mailing address

406 N FAXON RD
NORWOOD MN
55368-9507
US

V. Phone/Fax

Practice location:
  • Phone: 952-467-2888
  • Fax: 952-467-3258
Mailing address:
  • Phone: 952-467-2888
  • Fax: 952-467-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28725
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: