Basic Information
| Provider Information | |||||||||
| NPI: | 1033619515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JRK MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
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| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559035865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302169514 | ||||||||
| FaxNumber: | 7024535741 | ||||||||
| Practice Location | |||||||||
| Address1: | 2633 SUPERIOR DR NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559018395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073226900 | ||||||||
| FaxNumber: | 5073226967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2018 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | KALSI | ||||||||
| AuthorizedOfficialFirstName: | HENNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7347160967 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.