Healthcare Provider Details

I. General information

NPI: 1376231746
Provider Name (Legal Business Name): KENNITA RASHEDIAH SOLBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENNITA KENNEDY

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 BOTTINEAU BLVD STE 100
CRYSTAL MN
55429-3184
US

IV. Provider business mailing address

5700 BOTTINEAU BLVD STE 100
CRYSTAL MN
55429-3184
US

V. Phone/Fax

Practice location:
  • Phone: 763-504-6500
  • Fax: 763-537-1972
Mailing address:
  • Phone: 763-504-6500
  • Fax: 763-537-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79816
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: