MEDICARE: KEVIN MCELROY MD

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	2085R0202X	Diagnostic Radiology Physician	64800	MN
2	2085R0204X	Vascular & Interventional Radiology Physician	64800	MN

General Provider Information

NPI Number	:	1184151110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MCELROY MD

Provider Business Mailing Address
First Line	:	2355 HIGHWAY 36 W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3902
Country	:	US
Telephone Number	:	651-292-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 HIGHWAY 36 W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3902
Country	:	US
Telephone Number	:	651-292-2000
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	11/21/2023

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