Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 1366-TEP | WI |
Y | 207VX0000X | Obstetrician | 51151 | MN |
NPI | 1134184252 |
---|---|
Provider Name | Dimitri A. Kamenshikov |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Bloomington, MN 55425-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 11/03/2021 |