Provider Demographics
NPI:1942237946
Name:CHIPMAN, JEFFREY GREEN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GREEN
Last Name:CHIPMAN
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 11
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-7911
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1E
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43119208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1367517OtherARAZ
MN17-00026OtherMEDICA PRIMARY
MN17-00561OtherMEDICA CHOICE
MN317175200Medicaid
MN162A2CHOtherBCBS
MN151581OtherUCARE
MNHP31332OtherHEALTHPARTNERS
MN1027286OtherPREFERRED ONE
IA0546366Medicaid
WI34024900Medicaid
MNH27810Medicare UPIN
MN317175200Medicaid
IA0546366Medicaid