Provider Demographics
NPI:1962591974
Name:TOLAR, JAKUB (MD)
Entity type:Individual
Prefix:
First Name:JAKUB
Middle Name:
Last Name:TOLAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-2800
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:PWB 5TH FLOOR, STE 5-100 CLINIC 5B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-273-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42278208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12-02535OtherMEDICA CHOICE
MN1028458OtherPREFERRED ONE
FM1384114OtherARAZ
MN140923OtherUCARE
MN131326OtherFAIRVIEW
MN288656100Medicaid
MT0063240Medicaid
MN12-09026OtherMEDICA PRIMARY
MNHP33585OtherHEALTH PARTNERS
MT0063240Medicaid
MT0063240Medicaid