Provider Demographics
NPI:1114007705
Name:MARQUARDT, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:MARQUARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3585 LEXINGTON AVENUE NORTH
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8056
Mailing Address - Country:US
Mailing Address - Phone:651-251-5280
Mailing Address - Fax:651-251-5282
Practice Address - Street 1:3585 LEXINGTON AVENUE NORTH
Practice Address - Street 2:SUITE 350
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8056
Practice Address - Country:US
Practice Address - Phone:651-484-3942
Practice Address - Fax:651-787-0519
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN297722080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08280700Medicaid
MN08280700Medicaid