Provider Demographics
NPI:1639147069
Name:BLACK, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL STOP 11302C, HEALTHPARTNERS REGIONS BEHAVIORAL HEA
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4786
Practice Address - Fax:651-254-9426
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0920412084P0800X
MN543552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092041Medicaid
ILK24901Medicare PIN
F82881Medicare UPIN
IL256510Medicare PIN