Provider Demographics
NPI:1801993340
Name:KERSTEN, JENNIFER L (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:KERSTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7505 METRO BLVD 400
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3010
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET MALL
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2444
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNT1027112085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN452L4KEOtherBLUE CROSS BLUE SHIELD
MN1047601OtherPREFERRED ONE
MN172155000Medicaid
MNP00349001OtherRAILROAD MEDICARE MN
IA0732909Medicaid
MN133245OtherUCARE
WI34716600Medicaid
MNHP69501OtherHEALTHPARTNERS
MN1604280OtherMEDICA
MNHP69501OtherHEALTHPARTNERS
MN133245OtherUCARE
MNP00349001OtherRAILROAD MEDICARE MN
MN300004011Medicare PIN