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General NPI Number Information
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NPI Number | 1033404348
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Entity Type | Individual
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Provider Name | ANTHONY KOHLENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 4360 12TH AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379-1955
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Country | US
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Telephone | 651-968-5300
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Fax | 651-646-0205
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Provider Business Mailing Address
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Address Line | 710 COMMERCE DR STE 200
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City | WOODBURY
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State | MN
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Zip | 55125-4925
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 69261
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 69261
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License Number State | MN
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