MEDICARE: INTERVENTIONAL PROCEDURES GROUP LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085R0204X	Vascular & Interventional Radiology Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1003869140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PROCEDURES GROUP LTD

Provider Business Mailing Address
First Line	:	5775 WAYZATA BLVD.
Second Line	:	SUITE 400
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55416
Country	:	US
Telephone Number	:	952-542-8553
Fax Number	:	952-513-6880

Provider Business Practice Location Address
First Line	:	2445 NORTH MAYFAIR ROAD
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226
Country	:	US
Telephone Number	:	414-774-7226
Fax Number	:	414-774-6004

Authorized Official
Title or Position	:	OFFICER ON THE BOARD SECRETARY
Name	:	DONALD D JACOBSEN
Credential	:
Telephone Number	:	952-543-6500

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/02/2008

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