MEDICARE: DR. PATRICK THOMAS KOLLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35944	MN
2	207RI0011X	Interventional Cardiology Physician	35944	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205895075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK THOMAS KOLLER

Provider Business Mailing Address
First Line	:	45 WEST 10TH STREET
Second Line	:	3RD FLOOR
City	:	SAINT PAUL
State	:	MN
Zip	:	55102
Country	:	US
Telephone Number	:	651-232-3163
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 UNIVERSITY AVE W FL 6
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:	651-232-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	04/30/2018

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