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General NPI Number Information
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NPI Number | 1083526024
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Entity Type | Organization
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Legal Business Name | JA PLLC
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 11318 BEECHWOOD LANE
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City | WOODBURY
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State | MN
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Zip | 55129
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Country | US
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Telephone | 612-293-6855
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Fax | 651-369-5639
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE 6524
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 612-293-6855
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Fax | 651-369-5639
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH AZIZ
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Credential | MD
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Telephone | 612-293-6855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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