Healthcare Provider Details

I. General information

NPI: 1154335990
Provider Name (Legal Business Name): PRAMOD S KELKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 ELM CREEK BLVD N STE 360
MAPLE GROVE MN
55369-7076
US

IV. Provider business mailing address

12000 ELM CREEK BLVD N STE 360
MAPLE GROVE MN
55369-7076
US

V. Phone/Fax

Practice location:
  • Phone: 763-420-1010
  • Fax: 763-420-3710
Mailing address:
  • Phone: 763-420-1010
  • Fax: 763-420-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number41948
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: