Basic Information
| Provider Information | |||||||||
| NPI: | 1629173299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOCKEN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | FINK | ||||||||
| OtherFirstName: | PAULA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2910 CENTRE POINTE DRIVE | ||||||||
| Address2: | CHILDRENS HEALTH CARE | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518552109 | ||||||||
| FaxNumber: | 6518552310 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 CHICAGO AVENUE SOUTH | ||||||||
| Address2: | CHILDRENS HOSPITAL AND CLINICS EMERGENCY PHYSICIANS MPL | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128136111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | 32963 | MN | X | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PP0204X | 32963 | MN | X | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine | 208000000X | 32963 | MN | X | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0204X | 32963 | MN | X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
No ID Information.