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General NPI Number Information
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NPI Number | 1457417933
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Entity Type | Organization
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Legal Business Name | MIDWEST IMMUNOLOGY CLINICS, PLLC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 15655 37TH AVE N STE 250
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City | PLYMOUTH
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State | MN
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Zip | 55446-4000
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Country | US
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Telephone | 763-316-0750
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Fax | 616-954-3410
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Provider Business Mailing Address
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Address Line | 1726 COLE BLVD STE 250
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City | LAKEWOOD
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State | CO
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Zip | 80401-3262
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Country | US
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Telephone | 855-478-1528
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Fax | 720-465-5040
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Authorized Official
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Title or Position | OFFICER
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Name | DR. JASON PATRICK RAASCH
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Credential | M.D.
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Telephone | 763-577-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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