Provider Demographics
NPI:1437142924
Name:HALLMAN, KEVIN A (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:HALLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W. EXCHANGE ST
Mailing Address - Street 2:SUITE 622
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1225
Mailing Address - Country:US
Mailing Address - Phone:651-227-9141
Mailing Address - Fax:651-291-5992
Practice Address - Street 1:2101 WOODWINDS DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-227-9141
Practice Address - Fax:651-714-8255
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34055020207VX0000X
MN32868207VX0000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN32868OtherMN LICENSE
WI34055OtherWI LICENSE
WI0037Medicare ID - Type Unspecified