Provider Demographics
NPI:1922233287
Name:MICHAELS, JODI SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:SHARON
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1712
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:651-999-6840
Practice Address - Street 1:6025 LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1712
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6840
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2015-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN53722208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00957098OtherMEDICARE RR
MNP00957098OtherMEDICARE RR