Healthcare Provider Details

I. General information

NPI: 1760583140
Provider Name (Legal Business Name): IAN JAMES HEATH MDCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LABORE RD STE 104
VADNAIS HEIGHTS MN
55110-5186
US

IV. Provider business mailing address

3200 LABORE RD STE 104
VADNAIS HEIGHTS MN
55110-5186
US

V. Phone/Fax

Practice location:
  • Phone: 651-539-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39643
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number39643
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: