Basic Information
| Provider Information | |||||||||
| NPI: | 1114210036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMQUIST | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MILES | ||||||||
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| Credential: | JOE PALMQUIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 STINSON BLVD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126725346 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10961 CLUB WEST PKWY | ||||||||
| Address2: | |||||||||
| City: | BLAINE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554495866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635725700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 12/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/30/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 10940 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.