MEDICARE: ADULT MEDICINE PA

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	207R00000X	Internal Medicine Physician	26646	MN
2	133V00000X	Registered Dietitian	N153	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH5440	OTHER	MN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45Q68AN	OTHER	MN	BCBS
3	64544	OTHER	MN	HEALTHPARTNERS

General Provider Information

NPI Number	:	1740403393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT MEDICINE PA

Provider Business Mailing Address
First Line	:	393 DUNLAP ST N STE 235
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4208
Country	:	US
Telephone Number	:	651-644-7775
Fax Number	:	651-644-8884

Provider Business Practice Location Address
First Line	:	393 DUNLAP ST N STE 235
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4208
Country	:	US
Telephone Number	:	651-644-7775
Fax Number	:	651-644-8884

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBERLY A ANDERSON-UZPEN
Credential	:	MD
Telephone Number	:	651-644-7775

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	09/11/2025

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Directions to “ADULT MEDICINE PA ” Practice Location

Language	Start Address	Practice Location

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