Provider Demographics
NPI:1861469025
Name:BLOCK, JENNIFER H (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 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:651-293-8106
Practice Address - Street 1:205 WABASHA ST.
Practice Address - Street 2:HEALTHPARTNERS ST. PAUL URGENT CARE
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1805
Practice Address - Country:US
Practice Address - Phone:952-853-8800
Practice Address - Fax:651-293-8106
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42607207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120140900Medicaid
42607OtherMN MEDICAL LICENSE
42607OtherMN MEDICAL LICENSE
930001539Medicare ID - Type Unspecified