Healthcare Provider Details

I. General information

NPI: 1457417933
Provider Name (Legal Business Name): MIDWEST IMMUNOLOGY CLINICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 37TH AVE N STE 250
PLYMOUTH MN
55446-4000
US

IV. Provider business mailing address

1726 COLE BLVD STE 250
LAKEWOOD CO
80401-3262
US

V. Phone/Fax

Practice location:
  • Phone: 763-316-0750
  • Fax: 616-954-3410
Mailing address:
  • Phone: 855-478-1528
  • Fax: 720-465-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON PATRICK RAASCH
Title or Position: OFFICER
Credential: M.D.
Phone: 763-577-0008