Provider Demographics
NPI:1245236397
Name:KOHLI, JAGDEEP (MD)
Entity Type:Individual
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First Name:JAGDEEP
Middle Name:
Last Name:KOHLI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:910 E 26TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4552
Mailing Address - Country:US
Mailing Address - Phone:612-879-1000
Mailing Address - Fax:612-879-9116
Practice Address - Street 1:500 OSBORNE RD NE
Practice Address - Street 2:STE 365
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2769
Practice Address - Country:US
Practice Address - Phone:612-879-1000
Practice Address - Fax:612-879-9116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN395702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG44547Medicare UPIN