MEDICARE: MADELINE KLOSSNER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	12080	MN

General Provider Information

NPI Number	:	1023475258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE KLOSSNER PA-C

Provider Business Mailing Address
First Line	:	1700 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E NICOLLET BLVD STE 160
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4588
Country	:	US
Telephone Number	:	952-460-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	02/25/2026

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