Provider Demographics
NPI:1184679185
Name:PREIMESBERGER, KENNETH F (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:PREIMESBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN195072085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN14046PROtherBLUE CROSS
MN23005OtherAMERICA'S PPO
MN25Q35PROtherBLUE CROSS
MN300085341OtherRAILROAD MEDICARE MN
MNHP14197OtherHEALTHPARTNERS
IA0534339Medicaid
MN135295400Medicaid
MN0247012OtherPREFERRED ONE
MN100704OtherUCARE
WI300017562OtherRAILROAD MEDICARE WI
WI30626800Medicaid
WI001504070Medicare PIN
MNB58298Medicare UPIN
MN360000021Medicare PIN
MN23005OtherAMERICA'S PPO
MN100704OtherUCARE
MN14046PROtherBLUE CROSS