Individual
PHILIP BRUCE IMHOLTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 GOLF COURSE ROAD, GRAND RAPIDS, MN 55744
(218) 326-5000
(218) 999-1380
Mailing address
1601 GOLF COURSE ROAD, GRAND RAPIDS, MN 55744
(218) 326-5000
(218) 999-1380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49754
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760604623
MEDICA
—
01
—
17P85IM
BCBS
MN
05
—
244940000
—
MN
01
—
P00438363
RR MEDICARE PTAN
—
Enumeration date
05/02/2007
Last updated
10/21/2010
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