Provider Demographics
NPI:1275577454
Name:ANDERSON, JILL SHAREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:SHAREEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 493
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-4400
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB NINTH FLOOR, CLINIC 9A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46327207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN612T3ANOtherBCBS
MT0099654Medicaid
MN08-00043OtherMEDICA PRIMARY
MN2366355OtherARAZ
MNHP52462OtherHEALTHPARTNERS
MN053471400Medicaid
MN1043946OtherPREFERRED ONE
MN132844OtherUCARE
MN08-01243OtherMEDICA CHOICE
WI34816500Medicaid
MN1043946OtherPREFERRED ONE
MN180001220Medicare ID - Type UnspecifiedMN MEDICARE