Healthcare Provider Details

I. General information

NPI: 1447162425
Provider Name (Legal Business Name): IH PHYSICIAN SERVICES 2, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 LINDEN AVE SUITE A1
WHITE BEAR LAKE MN
55110-4625
US

IV. Provider business mailing address

655 BRAWLEY SCHOOL RD STE 200
MOORESVILLE NC
28117-9601
US

V. Phone/Fax

Practice location:
  • Phone: 763-326-2996
  • Fax:
Mailing address:
  • Phone: 704-664-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TYLER
Title or Position: VP OF REGULATORY COUNSEL
Credential: N/A
Phone: 678-449-0459