Individual
JEROME C SIY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8170 33RD AVE S, MC21110Q, BLOOMINGTON, MN 55425-4516
(651) 254-9594
(651) 254-3662
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516
(651) 254-3456
(651) 254-9673
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
42455
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333630100
—
MN
Enumeration date
02/06/2006
Last updated
08/07/2019
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