Basic Information
| Provider Information | |||||||||
| NPI: | 1891731907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLLER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | HERMAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | MMC 94 UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126262755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 DELAWARE ST SE, | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS MMC 94 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126262755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 03/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 17125 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | 17125 | MN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0202X | 17125 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1009248 | 01 | PREFERRED ONE | OTHER | 25-00282 | 01 | MEDICA PRIMARY | OTHER | 335772400 | 05 | MN | MEDICAID | A064 | 01 | CHAMPUS/TRICARE | OTHER | 100924 | 01 | UCARE | OTHER | 0047141 | 05 | MN | MEDICAID | 0251258 | 05 | OH | MEDICAID | 25-21110 | 01 | MEDICA CHOICE | OTHER | 2T299MO | 01 | MN | BCBS-MN | OTHER | 0971549 | 05 | MN | MEDICAID | 604478 | 01 | MN | ARAZ | OTHER | HP21998 | 01 | HEALTHPARTNERS | OTHER |