Provider Demographics
NPI:1558316620
Name:EDELMAN, KEVIN R (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN394802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1016758OtherPREFERRED ONE
MN10R69EDOtherBLUE CROSS
MN122865OtherUCARE
MN029R6EDOtherBLUE CROSS
MN3000088626OtherRAILROAD MEDICARE MN
IA0527200Medicaid
WI32646700Medicaid
MNHP26146OtherHEALTHPARTNERS
MN051020300Medicaid
WI300127014OtherRAILROAD MEDICARE WI
MN777973OtherAMERICA'S PPO
WI32646700Medicaid
MN300002943Medicare PIN
MN1016758OtherPREFERRED ONE
MN051020300Medicaid
WI002804070Medicare PIN
MN10R69EDOtherBLUE CROSS