Individual
JOHN HALVORSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1414 MARYLAND AVE E, UMPHYSICIANS PHALEN VILLAGE CLINIC, ST. PAUL, MN 55106
(651) 772-3461
(651) 772-5477
Mailing address
720 WASHINGTON AVE SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55414
(612) 884-0649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20514
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025128
HEALTH ALLIANCE
IL
05
—
0360893132
—
IL
01
—
080154707
RAILROAD MEDICARE
IL
01
—
472301
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
IL01P7
JOHN DEERE
IL
Enumeration date
07/28/2006
Last updated
02/07/2013
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