MEDICARE: KIDNEY SPECIALISTS OF MINNESOTA, PA

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	207RN0300X	Nephrology Physician		MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CP7137	OTHER	MN	RAILROAD MEDICARE
11	C01015	OTHER	MN	WPS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3100002	OTHER	MN	MEDICA PRIMARY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	361	OTHER	MN	HEALTHPARTNERS
9	12416KI	OTHER	MN	BCBSMN
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629010228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY SPECIALISTS OF MINNESOTA, PA

Provider Business Mailing Address
First Line	:	6200 SHINGLE CREEK PKWY STE 260
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2128
Country	:	US
Telephone Number	:	763-561-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 SHINGLE CREEK PKWY
Second Line	:	SUITE 260
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2128
Country	:	US
Telephone Number	:	763-561-5349
Fax Number	:

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	PATTY BUER
Credential	:
Telephone Number	:	763-561-5415

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	11/20/2025

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