Healthcare Provider Details

I. General information

NPI: 1194793554
Provider Name (Legal Business Name): KRISTOFFER M BREIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 EAGAN WOODS DR
EAGAN MN
55121-1138
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5201
  • Fax: 651-968-5903
Mailing address:
  • Phone:
  • Fax: 651-968-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number46672
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: