Individual
KENNETH D ENGBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 COMO AVE, SAINT PAUL, MN 55108
(651) 641-6200
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
(651) 641-6200
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
22842
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
720095100
—
MN
Enumeration date
02/17/2006
Last updated
10/21/2019
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