MEDICARE: JOEL KADEN

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	174400000X	Specialist	1155	MN

General Provider Information

NPI Number	:	1144678244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL KADEN

Provider Business Mailing Address
First Line	:	2438 BARCLAY ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 BARCLAY ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-2041
Country	:	US
Telephone Number	:	651-777-1087
Fax Number	:

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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