Basic Information
| Provider Information | |||||||||
| NPI: | 1184679185 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PREIMESBERGER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | 19507 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
ID Information
| ID | Type | State | Issuer | Description | 14046PR | 01 | MN | BLUE CROSS | OTHER | 23005 | 01 | MN | AMERICA'S PPO | OTHER | 25Q35PR | 01 | MN | BLUE CROSS | OTHER | 300085341 | 01 | MN | RAILROAD MEDICARE MN | OTHER | HP14197 | 01 | MN | HEALTHPARTNERS | OTHER | 0534339 | 05 | IA | MEDICAID | 135295400 | 05 | MN | MEDICAID | 0247012 | 01 | MN | PREFERRED ONE | OTHER | 100704 | 01 | MN | UCARE | OTHER | 300017562 | 01 | WI | RAILROAD MEDICARE WI | OTHER | 30626800 | 05 | WI | MEDICAID |