Individual
JOHN ROBERT HOLLERUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11107 ULYSSES ST NE STE 100, BLAINE, MN 55434-4264
(763) 333-7733
(763) 333-7711
Mailing address
11107 ULYSSES ST NE STE 100, BLAINE, MN 55434-4264
(763) 333-7733
(763) 333-7711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36159
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
895363500
—
MN
Enumeration date
08/24/2006
Last updated
06/30/2021
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