Provider Demographics
NPI:1518997840
Name:KEMBERLING, J KARL (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:J KARL
Middle Name:
Last Name:KEMBERLING
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3400
Mailing Address - Country:US
Mailing Address - Phone:952-927-6501
Mailing Address - Fax:
Practice Address - Street 1:7500 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3400
Practice Address - Country:US
Practice Address - Phone:952-927-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45758208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN916481200Medicaid
WI34426200Medicaid
MN340000780Medicare ID - Type Unspecified
WI34426200Medicaid