Provider Demographics
NPI:1891731907
Name:MOLLER, JAMES HERMAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HERMAN
Last Name:MOLLER
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 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 94 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-2755
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE,
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS MMC 94
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17125208000000X, 2080P0203X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1009248OtherPREFERRED ONE
25-00282OtherMEDICA PRIMARY
MN335772400Medicaid
A064OtherCHAMPUS/TRICARE
100924OtherUCARE
MN0047141Medicaid
OH0251258Medicaid
25-21110OtherMEDICA CHOICE
MN2T299MOOtherBCBS-MN
MN0971549Medicaid
MN604478OtherARAZ
HP21998OtherHEALTHPARTNERS
MN2T299MOOtherBCBS-MN
HP21998OtherHEALTHPARTNERS