Basic Information
Provider Information | |||||||||
NPI: | 1962466672 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EHLER | ||||||||
FirstName: | BARBARA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | EHLER | ||||||||
OtherFirstName: | BARBARA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 7301 OHMS LANE | ||||||||
Address2: | SUITE 650 | ||||||||
City: | EDINA | ||||||||
State: | MN | ||||||||
PostalCode: | 55439 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9528359880 | ||||||||
FaxNumber: | 9528571554 | ||||||||
Practice Location | |||||||||
Address1: | 201 E NICOLLET BLVD | ||||||||
Address2: | FAIRVIEW RIDGES HOSPITAL | ||||||||
City: | BURNSVILLE | ||||||||
State: | MN | ||||||||
PostalCode: | 55337 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9528922021 | ||||||||
FaxNumber: | 9528922670 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2006 | ||||||||
LastUpdateDate: | 09/25/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 47193 | MN | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207PP0204X | DR.0052982 | CO | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
ID Information
ID | Type | State | Issuer | Description | 470056200 | 05 | MN |   | MEDICAID |