Provider Demographics
NPI:1265409098
Name:KOLDOBA, GALINA L (MD)
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:L
Last Name:KOLDOBA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11475 ROBINSON DR NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3746
Mailing Address - Country:US
Mailing Address - Phone:763-587-9000
Mailing Address - Fax:763-587-9130
Practice Address - Street 1:11475 ROBINSON DR NW
Practice Address - Street 2:MAIL STOP 32600A
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3746
Practice Address - Country:US
Practice Address - Phone:763-754-4600
Practice Address - Fax:763-754-4614
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN47961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN638978300Medicaid
080014636Medicare ID - Type Unspecified
MN638978300Medicaid