Healthcare Provider Details

I. General information

NPI: 1184910218
Provider Name (Legal Business Name): BRIAN KESSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NORTH SMITH AVE
ST. PAUL MN
55102
US

IV. Provider business mailing address

2829 UNIVERSITY AVE SE STE 730
MINNEAPOLIS MN
55414-3279
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-6590
  • Fax:
Mailing address:
  • Phone: 612-439-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number61923-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57794
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: