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General NPI Number Information
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NPI Number | 1699270744
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Entity Type | Individual
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Provider Name | SHANE D KIRKEGAARD DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1575 BEAM AVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1126
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Country | US
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Telephone | 651-232-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO-05856
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 77259
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License Number State | MN
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