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General NPI Number Information
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NPI Number | 1740403393
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Entity Type | Organization
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Legal Business Name | ADULT MEDICINE PA
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 393 DUNLAP ST N STE 235
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City | SAINT PAUL
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State | MN
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Zip | 55104-4208
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Country | US
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Telephone | 651-644-7775
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Fax | 651-644-8884
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Provider Business Mailing Address
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Address Line | 393 DUNLAP ST N STE 235
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City | SAINT PAUL
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State | MN
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Zip | 55104-4208
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Country | US
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Telephone | 651-644-7775
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Fax | 651-644-8884
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIMBERLY A ANDERSON-UZPEN
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Credential | MD
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Telephone | 651-644-7775
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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 | 26646
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | N153
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License Number State | MN
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