Provider Demographics
NPI:1013974336
Name:JAHNKE, WILLIAM ROBERT II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:JAHNKE
Suffix:II
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 1:1959 SLOAN PLACE
Mailing Address - Street 2:STE 200
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2074
Mailing Address - Country:US
Mailing Address - Phone:651-772-6251
Mailing Address - Fax:651-224-9661
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:STE 250
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2594
Practice Address - Country:US
Practice Address - Phone:651-772-6251
Practice Address - Fax:651-224-9661
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25020207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B58277Medicare UPIN