Provider Demographics
NPI:1154335990
Name:KELKAR, PRAMOD S (MD)
Entity type:Individual
Prefix:
First Name:PRAMOD
Middle Name:S
Last Name:KELKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 ELM CREEK BLVD N STE 360
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7076
Mailing Address - Country:US
Mailing Address - Phone:763-420-1010
Mailing Address - Fax:763-420-3710
Practice Address - Street 1:12000 ELM CREEK BLVD N STE 360
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7076
Practice Address - Country:US
Practice Address - Phone:763-420-1010
Practice Address - Fax:763-420-3710
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41948207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN294M9KEOtherBLUE CROSS AND BLUE SHIEL
MN128142F031OtherUCARE
MN038588300Medicaid
MN1892372OtherAMERICAS PPO
MN677941040910OtherPREFERREDONE
MN0200201OtherMEDICA
MNHP40994OtherHEALTHPARTNERS
MNP00204492OtherRAILROAD MEDICARE
MN030000343Medicare PIN
MN294M9KEOtherBLUE CROSS AND BLUE SHIEL
MN038588300Medicaid