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Individual

JEFFREY OWEN KASBOHM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
6341 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4946
(763) 572-5710
(763) 586-5888
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9692
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0110266
MEDICA
MN
01
1030604
PREFERRED ONE
MN
01
141816
UCARE MN
MN
01
1639459
AMERICA'S PPO
MN
01
64G07KA
BCBS OF MN
MN
01
6605100
MEDICA URGENT CARE
MN
01
HP35076
HEALTHPARTNERS
MN
Enumeration date
09/01/2006
Last updated
07/09/2007
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