Healthcare Provider Details

I. General information

NPI: 1356667984
Provider Name (Legal Business Name): JUSTIN KYLE HALBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 UNIVERSITY AVE W
SAINT PAUL MN
55104-4001
US

IV. Provider business mailing address

1690 UNIVERSITY AVE W STE 370
SAINT PAUL MN
55104-3723
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-4800
  • Fax:
Mailing address:
  • Phone: 651-232-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0438840
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number63322
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: