Provider Demographics
NPI:1578590881
Name:KELLOGG, TODD ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39652208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN17-00026OtherMEDICA PRIMARY
MN1874804OtherARAZ
MNHP40341OtherHEALTHPARTNERS
MT0059959Medicaid
MN1018950OtherPREFERRED ONE
MN17-01028OtherMEDICA CHOICE
MN857973300OtherMN MA
MN528A4KEOtherBCBS
MN171564OtherUCARE
MNENROLLEDMedicaid
MNP01095104OtherMEDICARE RAILROAD
MN528A4KEOtherBCBS
MNP01095104OtherMEDICARE RAILROAD
MNG55087Medicare UPIN