Healthcare Provider Details

I. General information

NPI: 1144894700
Provider Name (Legal Business Name): JOHN MATTHEW ZIEGLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 LOUISIANA AVE S
ST LOUIS PARK MN
55426-4375
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number79857
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: