Provider Demographics
NPI:1790778090
Name:WIRE, JAMES PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PHILIP
Last Name:WIRE
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 1:3000 HUNDERTMARK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1150
Mailing Address - Country:US
Mailing Address - Phone:952-442-8045
Mailing Address - Fax:952-556-2658
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:952-442-8045
Practice Address - Fax:952-556-2658
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
MN430872086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH20075Medicare UPIN