Provider Demographics
NPI:1194792978
Name:KLODAS, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KLODAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1706
Mailing Address - Country:US
Mailing Address - Phone:952-456-7000
Mailing Address - Fax:952-456-7001
Practice Address - Street 1:6545 FRANCE AVENUE S.
Practice Address - Street 2:SUITE 125
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-929-5600
Practice Address - Fax:952-929-5610
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32079207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN044217800Medicaid
F46559Medicare UPIN
MN044217800Medicaid