Basic Information
| Provider Information | |||||||||
| NPI: | 1447296660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOHJANEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE STREET SE, MMC 98 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126258625 | ||||||||
| FaxNumber: | 6126246678 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 516 DELAWARE STREET SE, PWB FIFTH FLOOR, CLINIC 5A | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126255656 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 42817 | MN | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 03-00080 | 01 | MN | MEDICA CHOICE | OTHER | 2239480 | 01 | MN | CIGNA HEALTHCARE | OTHER | 906404400 | 05 | MN | MEDICAID | 1038401 | 01 | MN | ARAZ | OTHER | HP31368 | 01 | MN | HEALTHPARTNERS | OTHER | B161 | 01 | MN | CHAMPUS/TRIWEST | OTHER | 03-00010 | 01 | MN | MEDICA PRIMARY | OTHER | 1024672 | 01 | MN | PREFERRED ONE | OTHER | 77R89BO | 01 | MN | BCBS | OTHER | 0534230 | 05 | IA | MEDICAID | 127909 | 01 | MN | UCARE | OTHER | 34011100 | 05 | WI | MEDICAID |