Provider Demographics
NPI:1558316620
Name:EDELMAN, KEVIN R (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:EDELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3768 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2420
Mailing Address - Country:US
Mailing Address - Phone:651-452-4746
Mailing Address - Fax:
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN394802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN029R6EDOtherBLUE CROSS
MN777973OtherAMERICA'S PPO
MN1016758OtherPREFERRED ONE
MN3000088626OtherRAILROAD MEDICARE MN
MNHP26146OtherHEALTHPARTNERS
MN122865OtherUCARE
WI32646700Medicaid
MN10R69EDOtherBLUE CROSS
IA0527200Medicaid
WI300127014OtherRAILROAD MEDICARE WI
MN051020300Medicaid
WI32646700Medicaid
MN300002943Medicare PIN
MN1016758OtherPREFERRED ONE
MN051020300Medicaid
WI002804070Medicare PIN
MN10R69EDOtherBLUE CROSS