Provider Demographics
NPI:1992769533
Name:ENDOCRINOLOGY CLINIC OF MINNEAPOLIS PA
Entity type:Organization
Organization Name:ENDOCRINOLOGY CLINIC OF MINNEAPOLIS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:RUEGEMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-927-7810
Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:SUITE 180
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5845
Mailing Address - Country:US
Mailing Address - Phone:952-927-7810
Mailing Address - Fax:952-927-6309
Practice Address - Street 1:7701 YORK AVE S
Practice Address - Street 2:SUITE 180
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5845
Practice Address - Country:US
Practice Address - Phone:952-927-7810
Practice Address - Fax:952-927-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN96054OtherPREFERRED ONE
MNC626OtherUCARE
MN184810100Medicaid
MN3100OtherHEALTH PARTNERS
MN53964THOtherBLUE CROSS BLUE SHIELD
MN184810100Medicaid
MN53964THOtherBLUE CROSS BLUE SHIELD