KENNETH B HEITHOFF (NPI# 1063477131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063477131 |
| Entity Type | Individual |
| Full Name | KENNETH B HEITHOFF |
| Credential | MD |
| Practice Address |
5775 Wayzata Boulevard Suite 190 St Louis Park MN 55416 |
| Mailing Address |
Po Box 1414 Ncb-6 Minneapolis MN 55480-1414 |
| Practice Telephone | 9525411840 |
| Practice Fax Number | 9525136880 |
| Mailing Telephone | 9525428553 |
| Mailing Fax Number | 9525136880 |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
18169 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
5775 WAYZATA BOULEVARD SUITE 190 |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982671764 | Hollis M Fritts | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-01 |
| 1306813399 | Lorin P Broadbent | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-08 |
| 1215904560 | Thomas J Gilbert Jr. | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-07 |
| 1386611572 | John A Eklund | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-07 |
| 1245207687 | Cdi Twin Cities Asc LLC | Clinic/Center | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-03 |
| 1235106816 | Ronald S Pobiel | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-02 |
| 1659348431 | Cooper R Gundry | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609392349 | Rai Keystone Imaging Services, LLC | Radiology | 5775 Wayzata Blvd Ste 400, St Louis Park, MN 55416-1271 | 2017-08-15 |
| 1982671764 | Hollis M Fritts | Radiology | 5775 Wayzata Boulevard, Suite 190, St Louis Park, MN 55416 | 2006-03-01 |
| 1073592960 | Mark E Myers | Radiology | 5775 Wayzata Blvd, Suite 190, St Louis Park, MN 55416-1222 | 2006-01-10 |
| 1891105482 | Nicholas G. Matthees | Radiology | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2014-05-05 |
| 1528327954 | Blake Carlson | Radiology | 5775 Wayzata Blvd Ste 190, St Louis Park, MN 55416 | 2012-05-04 |
| 1053603381 | Elizabeth Ann Lindgren | Radiology | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2011-05-04 |
| 1528389004 | Joshua Zawacki | Radiology | 5775 Wayzata Blvd Ste 190, St Louis Park, MN 55416-2627 | 2010-06-18 |
| 1326367160 | Kristin Marit England | Radiology | 5775 Wayzata Blvd Ste 190, St Louis Park, MN 55416-2627 | 2010-05-19 |
| 1659698645 | Christopher Neeley | Radiology | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2010-04-29 |
| 1487979167 | Michael Bruce Salmela | Radiology | 3931 Louisiana Ave S, Park Nicollet- Meadowbrook, Suite W115, St Louis Park, MN 55426-5000 | 2010-04-06 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
Please comment or provide details below to improve the information on KENNETH B HEITHOFF.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.