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NPI Code Detail

MEDICARE: JESSICA JANE KOLB M.D.

MEDICARE: JESSICA JANE KOLB M.D.
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
1207Q00000XFamily Medicine PhysicianA142616CA
2390200000XStudent in an Organized Health Care Education/Training Program
3207Q00000XFamily Medicine Physician64616MN

General Provider Information

NPI Number : 1083029920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA JANE KOLB M.D.
Provider Business Mailing Address
First Line : 3300 OAKDALE AVE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422
Country : US
Telephone Number : 763-520-5200
Fax Number : 763-581-6401
Provider Business Practice Location Address
First Line : 4209 WEBBER PKWY
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-1747
Country : US
Telephone Number : 763-581-5750
Fax Number : 763-581-5751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 02/06/2020

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