Healthcare Provider Details

I. General information

NPI: 1609818657
Provider Name (Legal Business Name): JAMES A MESEROW M.D., F.A.C.O.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 30TH AVE S STE 102
GRAND FORKS ND
58201-6009
US

IV. Provider business mailing address

1200 PLEASANT STREET SOUTH 2 ROOM 236
DES MOINES IA
50309-1406
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax:
Mailing address:
  • Phone: 515-241-6228
  • Fax: 515-241-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number61-4418
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberU0257
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMC-0085
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036-059865
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberU0257
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD-45006
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: