Provider Demographics
NPI:1487946026
Name:CHRISTENSEN, KEVIN NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NICHOLAS
Last Name:CHRISTENSEN
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 1:4270 MAINE AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6936
Mailing Address - Country:US
Mailing Address - Phone:507-206-3211
Mailing Address - Fax:507-206-3040
Practice Address - Street 1:4270 MAINE AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6936
Practice Address - Country:US
Practice Address - Phone:507-206-3211
Practice Address - Fax:507-206-3040
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106319207N00000X
MN55584207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNP01261102OtherRAILROAD MEDICARE
MNENROLLEDMedicaid