Basic Information
Provider Information
NPI: 1881886018
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KASBOHM
FirstName: MEREDITH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6565 FRANCE AVE S
Address2: SUITE 200
City: EDINA
State: MN
PostalCode: 554352137
CountryCode: US
TelephoneNumber: 9528060011
FaxNumber: 9528069741
Practice Location
Address1: 6565 FRANCE AVE S
Address2: SUITE 200
City: EDINA
State: MN
PostalCode: 554352137
CountryCode: US
TelephoneNumber: 9528060011
FaxNumber: 9528069741
Other Information
ProviderEnumerationDate: 08/12/2007
LastUpdateDate: 03/07/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0000X51499MNY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics

No ID Information.


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