Provider Demographics
NPI:1447296660
Name:BOHJANEN, KIMBERLY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:BOHJANEN
Suffix:
Gender:F
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 98
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-8625
Mailing Address - Fax:612-624-6678
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FIFTH FLOOR, CLINIC 5A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42817207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03-00080OtherMEDICA CHOICE
MN2239480OtherCIGNA HEALTHCARE
MN906404400Medicaid
MN1038401OtherARAZ
MNHP31368OtherHEALTHPARTNERS
MNB161OtherCHAMPUS/TRIWEST
MN03-00010OtherMEDICA PRIMARY
MN1024672OtherPREFERRED ONE
MN77R89BOOtherBCBS
IA0534230Medicaid
MN127909OtherUCARE
WI34011100Medicaid
IA0534230Medicaid
MNHP31368OtherHEALTHPARTNERS
MN1024672OtherPREFERRED ONE