Provider Demographics
NPI:1780656793
Name:WEBER, PHILIP J (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:WEBER
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:952-883-5375
Mailing Address - Fax:651-552-2614
Practice Address - Street 1:5625 CENEX DR - MAIL STOP 33100A
Practice Address - Street 2:HEALTH PARTNERS INVER GROVE HEIGHTS CLINIC
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1735
Practice Address - Country:US
Practice Address - Phone:651-552-2600
Practice Address - Fax:651-552-2614
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-12-01
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Provider Licenses
StateLicense IDTaxonomies
MN33373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN548000100Medicaid
080006805Medicare ID - Type Unspecified
MN548000100Medicaid