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NPI Code Detail

MEDICARE: MICHELLE M BLAESER MD

MEDICARE: MICHELLE M BLAESER MD
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
1207R00000XInternal Medicine Physician37596MN
2207N00000XDermatology Physician37596MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619954963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE M BLAESER MD
Provider Business Mailing Address
First Line : 701 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55415-1623
Country : US
Telephone Number : 612-873-3000
Fax Number :
Provider Business Practice Location Address
First Line : 715 S 8TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-7530
Country : US
Telephone Number : 612-873-6963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 08/25/2025

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