Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 3440 | MN |
Y | 213ER0200X | Radiology | 3440 | MN |
NPI | 1043483084 |
---|---|
Provider Name | Dr. Peter Lee Kelzenberg |
First Address | Osseo, MN 55369 |
Second Address | Osseo, MN 55369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02D86OS | BCBS (01) | MN |
44-40379 | MEDICA (01) | MN |
604271 | HEALTH PARTNERS (01) | MN |
U64004 | (02) | MN |