Provider Demographics
NPI:1649242918
Name:ENGMAN, JONATHAN H (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:ENGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6533 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2103
Mailing Address - Country:US
Mailing Address - Phone:952-927-7138
Mailing Address - Fax:952-924-4021
Practice Address - Street 1:6533 DREW AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2103
Practice Address - Country:US
Practice Address - Phone:952-927-7138
Practice Address - Fax:952-924-4021
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47408207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN510602800Medicaid
MN510602800Medicaid
I28999Medicare UPIN