Provider Demographics
NPI:1083029920
Name:KOLB, JESSICA JANE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:KOLB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-520-5200
Mailing Address - Fax:763-581-6401
Practice Address - Street 1:4209 WEBBER PKWY
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1747
Practice Address - Country:US
Practice Address - Phone:763-581-5750
Practice Address - Fax:763-581-5751
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142616207Q00000X
390200000X
MN64616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program