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Organization
EDEN PRAIRIE CLINIC, PA
Active
Organization
EDEN PRAIRIE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RADHA KRISHNA KUMAR M.D. (OWNER)
(952) 944-6989
Entity
Organization
Contact information
Practice address
9358 ENSIGN AVE S, SUITE C, BLOOMINGTON, MN 55438-1472
(952) 944-6989
Mailing address
9358 ENSIGN AVE S, SUITE C, BLOOMINGTON, MN 55438-1472
(952) 944-6989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
10/27/2010
Last updated
10/28/2010
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