MEDICARE: HEIDI R KIMMEL PAC

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	9579	MN

General Provider Information

NPI Number	:	1124085303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI R KIMMEL PAC

Provider Business Mailing Address
First Line	:	733 CHICAGO DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-6448
Country	:	US
Telephone Number	:	952-892-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	6363 FRANCE AVE S
Second Line	:	STE 525
City	:	EDINA
State	:	MN
Zip	:	55435-2129
Country	:	US
Telephone Number	:	952-926-6489
Fax Number	:	952-926-6501

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

Provider Enumeration Date	:	04/29/2006
Last Update Date	:	10/07/2011

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Directions to “ HEIDI R KIMMEL PAC” Practice Location

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