Provider Demographics
NPI:1386611572
Name:EKLUND, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:EKLUND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1414
Mailing Address - Street 2:NCB 6
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55480-1414
Mailing Address - Country:US
Mailing Address - Phone:952-542-8553
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:5775 WAYZATA BOULEVARD
Practice Address - Street 2:SUITE 190
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-541-1840
Practice Address - Fax:652-513-6880
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN428702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN590000000Medicaid
MN590000000Medicaid
MN300002289Medicare ID - Type Unspecified