Healthcare Provider Details

I. General information

NPI: 1194042887
Provider Name (Legal Business Name): AARON KYLE GRAUMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 NICOLLET AVE S
BLOOMINGTON MN
55420-2824
US

IV. Provider business mailing address

8600 NICOLLET AVE S
BLOOMINGTON MN
55420-2824
US

V. Phone/Fax

Practice location:
  • Phone: 605-261-5044
  • Fax:
Mailing address:
  • Phone: 605-261-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55632
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55632
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number55632
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: