Healthcare Provider Details

I. General information

NPI: 1417047879
Provider Name (Legal Business Name): DANIEL P KOHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 WAYZATA BLVD SUITE #200
MINNETONKA MN
55305-1502
US

IV. Provider business mailing address

10505 WAYZATA BLVD SUITE #200
MINNETONKA MN
55305-1502
US

V. Phone/Fax

Practice location:
  • Phone: 763-546-5797
  • Fax: 763-546-5754
Mailing address:
  • Phone: 763-546-5797
  • Fax: 763-546-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24205
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: