Individual
SHIRE JAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Mailing address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
71737
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
04/25/2019
Last updated
08/26/2022
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