Healthcare Provider Details

I. General information

NPI: 1902884828
Provider Name (Legal Business Name): HENNA KALSI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 BIELENBERG DR STE 208
WOODBURY MN
55125-1700
US

IV. Provider business mailing address

PO BOX 5865
ROCHESTER MN
55903-5865
US

V. Phone/Fax

Practice location:
  • Phone: 651-765-8346
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: