Provider Demographics
NPI:1588829428
Name:GALE, JONATHAN DONALD (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DONALD
Last Name:GALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 28TH ST STE 460
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1286
Mailing Address - Country:US
Mailing Address - Phone:612-863-7770
Mailing Address - Fax:612-863-7772
Practice Address - Street 1:2545 CHICAGO AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4522
Practice Address - Country:US
Practice Address - Phone:612-863-7770
Practice Address - Fax:612-863-7772
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53609208600000X
MN107901208600000X
390200000X
MN585602086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program