Provider Demographics
NPI:1447227236
Name:SCHELLHAS, KURT P (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:P
Last Name:SCHELLHAS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:NW 6035
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-6035
Mailing Address - Country:US
Mailing Address - Phone:952-542-8553
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:5775 WAYZATA BLVD
Practice Address - Street 2:STE 190
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-541-1840
Practice Address - Fax:952-513-6880
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN236372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN859267500Medicaid
MN300000228Medicare ID - Type Unspecified
MN859267500Medicaid