Provider Demographics
NPI:1659307205
Name:PARTOLL, KURT STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:STEVEN
Last Name:PARTOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 W BROADWAY AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1924
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7066
Practice Address - Street 1:5109 36TH AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2007
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7989
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN31337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN975888700Medicaid
MN975888700Medicaid
MNA95856Medicare UPIN