Healthcare Provider Details

I. General information

NPI: 1861468639
Provider Name (Legal Business Name): JAGDEEP S BIJWADIA MD, FCCP, DABSM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 9TH ST SE
ROCHESTER MN
55904-6756
US

IV. Provider business mailing address

784 LINWOOD AVE
SAINT PAUL MN
55105-3322
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-3443
  • Fax:
Mailing address:
  • Phone: 612-618-1402
  • Fax: 651-493-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number40706
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number46171
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number46171
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: