=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194189753
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JAEGER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2016
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 FODEN RD STE 103
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-828-1122
-----------------------------------------------------
Fax | 207-828-0188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 PARK AVE HENNEPIN COUNTY MEDICAL CENTER, INTERNAL MEDICINE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-873-2702
-----------------------------------------------------
Fax | 612-904-4577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | MD25838
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------