Provider Demographics
NPI:1477628998
Name:HILL, JOHN JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JACOB
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:734 AMBER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-4101
Mailing Address - Country:US
Mailing Address - Phone:651-483-5147
Mailing Address - Fax:651-330-9197
Practice Address - Street 1:400 S FOURTH ST
Practice Address - Street 2:#201 METROPOLITAN HEALTH PLAN
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-347-8557
Practice Address - Fax:612-904-4265
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNMN20164207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A94154Medicare UPIN