Healthcare Provider Details

I. General information

NPI: 1194179085
Provider Name (Legal Business Name): KNUT-KJELL HOVERSTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KNUT HOVERSTEN M.D.

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 05/01/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-495-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number73974
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10579233-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: