Provider Demographics
NPI:1972699635
Name:VAN KUIJK, FREDERICUS J (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICUS
Middle Name:J
Last Name:VAN KUIJK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERIK
Other - Middle Name:J
Other - Last Name:VAN KUIJK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE STREET SE / MMC493
Practice Address - Street 2:9TH FLOOR PWB
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54780207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8603J3Medicare ID - Type UnspecifiedMEDICARE FOR UTMB
H06144Medicare UPIN