MEDICARE: UHURA FIELDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	744968	MN

General Provider Information

NPI Number	:	1407695919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UHURA FIELDS

Provider Business Mailing Address
First Line	:	500 CEDAR ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-2245
Country	:	US
Telephone Number	:	651-356-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CEDAR ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-2245
Country	:	US
Telephone Number	:	651-356-2405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/23/2024

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