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General NPI Number Information
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NPI Number | 1528898038
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Entity Type | Individual
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Provider Name | JOHN CHARLES HENNESSEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 401 PHALEN BLVD HEALTHPARTNERS SPECIALTY CENTER - VASCULAR SURGERY 4TH
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City | SAINT PAUL
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State | MN
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Zip | 55130-5302
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Country | US
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Telephone | 952-967-7977
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Fax | 651-254-7969
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S # MS 21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 333269
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 85238-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 78317
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License Number State | MN
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