Provider Demographics
NPI:1669679486
Name:EXSTED, KYLE R (PAC)
Entity Type:Individual
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First Name:KYLE
Middle Name:R
Last Name:EXSTED
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:3366 OAKDALE AVE N
Practice Address - Street 2:SUITES 103 & 104
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-520-7870
Practice Address - Fax:763-520-7889
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MN10293363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant