Healthcare Provider Details

I. General information

NPI: 1871942854
Provider Name (Legal Business Name): MOHINEESH KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHINEESH KR M.D.

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FULTON ST SE
MINNEAPOLIS MN
55455-4800
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W FL 6
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number79650
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301110356
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number01090094
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: