Provider Demographics
NPI:1407148315
Name:KEALHOFER, JESSICA V (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:V
Last Name:KEALHOFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 508
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-9100
Mailing Address - Fax:612-625-3238
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:MMC 508
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-626-9100
Practice Address - Fax:612-625-3238
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2016-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MN55498207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine