Healthcare Provider Details

I. General information

NPI: 1821552134
Provider Name (Legal Business Name): BESS MICHELLE KUZMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BESS MICHELLE RUBIN

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JACOB LN
ANOKA MN
55303-1776
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4200
  • Fax: 763-587-4205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12921
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: