KENNETH D ENGBERG (NPI# 1952376527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952376527 |
| Entity Type | Individual |
| Full Name | KENNETH D ENGBERG |
| Credential | MD |
| Practice Address |
2500 Como Ave Saint Paul MN 55108 |
| Mailing Address |
8170 33rd Ave S # Ms 21110q Minneapolis MN 55425-4516 |
| Practice Telephone | 6516416200 |
| Mailing Telephone | 6516416200 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2019-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
22842 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 720095100 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 401 Phalen Blvd, Mc41103f, Saint Paul, MN 551305302 | 6512547600 | 6512547623 |
| Street Address |
2500 COMO AVE |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942295050 | Kara Serene Boyko Frandson | Pharmacist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2005-09-14 |
| 1205333275 | David Bryan Polley | Registered Nurse | 2500 Como Ave, Saint Paul, MN 55108 | 2018-04-06 |
| 1578065348 | Crystalyn Morton | Registered Nurse | 2500 Como Ave, Mail Stop 31100a, Saint Paul, MN 55108-1460 | 2018-03-07 |
| 1831610401 | Dema Mohammed | Pharmacist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-07-04 |
| 1225568520 | Lauren Michele Soukup | Optometrist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-06-19 |
| 1174059166 | Elliott Scott Foss | Physician Assistant | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-05-11 |
| 1376081133 | Estella Dennis | Registered Nurse | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2017-02-01 |
| 1619411808 | Katherine A. Becker | Physician Assistant | 2500 Como Ave, Saint Paul, MN 55108 | 2016-12-07 |
| 1528428398 | Jacquelyn Wright Wagner | Psychologist | 2500 Como Ave, Saint Paul, MN 55108-1460 | 2016-03-07 |
| 1821479403 | Karisa Jean Etter | Optometrist | 2500 Como Ave, Saint Paul, MN 55108 | 2015-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490677 | Kyle Leonard Bernier | Student in an Organized Health Care Education/Training Program | 1295 Bandana Blvd W, Suite 210, St. Paul, MN 55108 | 2019-07-25 |
| 1356870778 | Kathleen Louise Kocon | Marriage & Family Therapist | 2230 Como Ave., Saint Paul, MN 55108 | 2017-06-08 |
| 1871965830 | Jill Hansen | Specialist | 1449 Clevland Ave N, The Emily Program, Saint Paul, MN 55108 | 2015-10-29 |
| 1871821140 | Angela Joyce Anderson | Speech-Language Pathologist | 2266 Hillside Avenue, Saint Paul, MN 55108 | 2009-11-25 |
| 1265769418 | Dakota Baker | Counselor | 1360 Energy Park Drive Suite 340, St. Paul, MN 55108 | 2009-11-09 |
| 1255583449 | Suzanne Elizabeth Trunnell | Nurse Practitioner | 1020 Bandana Blvd. W, Aspen Medical Group--bandana Square, St. Paul, MN 55108 | 2008-10-21 |
| 1982851358 | Kimberly Joy Bahma | Pharmacist | 1295 Bandana Blvd, Suite 335, Saint Paul, MN 55108 | 2008-08-27 |
| 1952566093 | Caring Professionals Homecare, LLC | Home Health | 1543 Como Ave Ste 101, Saint Paul, MN 55108 | 2008-07-28 |
| 1700077344 | Archana Mani | Dentist | 1021 Bandana Blvd E Ste 121, Saint Paul, MN 55108 | 2007-08-08 |
| 1457554735 | Catherine Lawrence Scharlau | Psychologist | 1295 Bandana Blvd. North, Aspen Medical Group-behavioral Health, St. Paul, MN 55108 | 2007-06-06 |
| Find all providers in zip 55108 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023039377 | George Nicholas Battis Jr. | Internal Medicine | 400 Robert St N # 13-3996, Saint Paul, MN 55101-2037 | 2006-07-22 |
| 1164074787 | Kristen Engstrom | Internal Medicine | 640 Jackson St, Saint Paul, MN 55101 | 2019-07-13 |
| 1417078940 | Alvin C. Holm, Md, Facp, Pa | Internal Medicine | 559 Capitol Blvd, Saint Paul, MN 55103-2101 | 2007-04-02 |
| 1265529663 | Lissa N Chipeco | Internal Medicine | 401 Phalen Blvd, Ms 41103f, Saint Paul, MN 55130-5302 | 2006-10-06 |
| 1265546188 | Alvin C Holm | Internal Medicine | 559 Capitol Blvd, Saint Paul, MN 55103-2101 | 2006-08-18 |
| 1487629424 | Michael T Spilane | Internal Medicine | 401 Phalen Blvd, Ms 41103f, Saint Paul, MN 55130-5302 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083268189 | Mission Creek Transitional Care Pllc | Internal Medicine | 520 Marshall St, Duluth, MN 55803-1981 | 2019-07-26 |
| 1275191736 | Howide Eldib | Internal Medicine | 4728 Lyndale Ave S Apt 1, Minneapolis, MN 55419-5304 | 2019-05-30 |
| 1689007940 | David Pautz | Internal Medicine | 6313 Westwood Ct, Edina, MN 55436-1149 | 2013-08-09 |
| 1033465505 | Manji Belinda Osifeso | Internal Medicine | 790 West 66th Street, Hcmc Richfield Clinic, Richfield, MN 55423 | 2012-08-01 |
| 1508147224 | Jane Carol Pederson | Internal Medicine | 9478 Wedgewood Dr, Woodbury, MN 55125-9304 | 2011-09-08 |
| 1336445899 | Diane Helen Scott | Internal Medicine | 2545 Hamline Ave N, Apt 211, Roseville, MN 55113 | 2011-02-01 |
| 1497981286 | House Call Specialists, Pllc | Internal Medicine | 115 Oregon Ave S, Golden Valley, MN 55426-1561 | 2009-06-07 |
| 1952582744 | Maged Labib | Internal Medicine | 1920 Mineral Springs Pkwy, Owatonna, MN 55060-2186 | 2007-11-20 |
| 1912118522 | Bernadette Kim Quadling | Internal Medicine | 1415 Lilac Dr N, Ste 190, Golden Valley, MN 55422-4544 | 2007-05-25 |
| 1912046988 | Margaret Rice, Md, Pa | Internal Medicine | 4901 Garfield Ave, Minneapolis, MN 55419-5403 | 2007-02-06 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PAUL |
| Zip Code | 55108 |
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| 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.