Healthcare Provider Details

I. General information

NPI: 1437142924
Provider Name (Legal Business Name): KEVIN A HALLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WOODWINDS DRIVE SUITE 300
WOODBURY MN
55125
US

IV. Provider business mailing address

17 W. EXCHANGE ST SUITE 622
ST. PAUL MN
55102-1225
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-9141
  • Fax: 651-714-8255
Mailing address:
  • Phone: 651-227-9141
  • Fax: 651-291-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number34055020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number32868
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number32868
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: