Individual
PAMELA KOLACZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6320 WEDGWOOD RD N, MAPLE GROVE, MN 55311-3647
(763) 268-0400
(763) 268-0405
Mailing address
6320 WEDGWOOD RD N, MAPLE GROVE, MN 55311-3647
(763) 268-0400
(763) 268-0405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42205
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22G83KO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/14/2006
Last updated
04/13/2012
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