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NPI Code Detail

MEDICARE: DR. JAKE S JASURDA

MEDICARE: DR. JAKE S JASURDA
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
1207RG0100XGastroenterology Physician156183IL

General Provider Information

NPI Number : 1578096350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAKE S JASURDA
Provider Business Mailing Address
First Line : PO BOX 14909
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-0909
Country : US
Telephone Number : 612-871-1145
Fax Number : 612-870-5491
Provider Business Practice Location Address
First Line : 18465 ORCHARD TRL STE 320
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-2522
Country : US
Telephone Number : 612-871-1145
Fax Number : 612-870-5491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2017
Last Update Date : 08/13/2024

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