Basic Information
| Provider Information | |||||||||
| NPI: | 1013974336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAHNKE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ROBERT | ||||||||
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| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1959 SLOAN PLACE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517726251 | ||||||||
| FaxNumber: | 6512249661 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 SHERMAN ST | ||||||||
| Address2: | STE 250 | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517726251 | ||||||||
| FaxNumber: | 6512249661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25020 | MN | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 25020 | MN | X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.