Basic Information
| Provider Information | |||||||||
| NPI: | 1770573669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 137TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | HAM LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553047350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632024582 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7301 OHMS LANE, SUITE 650 | ||||||||
| Address2: | EMERGENCY PHYSICIANS, P.A. | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554394000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528579880 | ||||||||
| FaxNumber: | 9528571554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5110 | AK | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 40368 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.