Provider Demographics
NPI:1811950058
Name:ENGELKING, JON H (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:H
Last Name:ENGELKING
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 1:218 EASTBANK CT N
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1083
Mailing Address - Country:US
Mailing Address - Phone:715-377-7698
Mailing Address - Fax:715-377-7698
Practice Address - Street 1:218 EASTBANK CT N
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1083
Practice Address - Country:US
Practice Address - Phone:715-377-7698
Practice Address - Fax:715-377-7698
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29551207X00000X
WI29716207X00000X
MS20727207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN069888100Medicaid
MNHP13235OtherHEALTHPARTNERS
MN0245007OtherPREFERRED ONE
MN4268943OtherAETNA
MN068K0ENOtherBCBS OF MN
MN102956OtherUCARE MN
MN0901080OtherMEDICA
MN0901080OtherMEDICA
MN200001999Medicare ID - Type Unspecified
MNHP13235OtherHEALTHPARTNERS