Provider Demographics
NPI:1487612164
Name:KHARBANDA, ELYSE O (MD)
Entity type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:O
Last Name:KHARBANDA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-702-5305
Practice Address - Street 1:8450 SEASONS PKWY - MAIL STOP 32900A
Practice Address - Street 2:HEALTHPARTNERS WOODBURY CLINIC
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4402
Practice Address - Country:US
Practice Address - Phone:651-702-5300
Practice Address - Fax:651-702-5305
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MN105050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105050OtherMN MEDICAL LICENSE (TEMPORARY)
MNBO7215355OtherMN DEA
MN105050OtherMN MEDICAL LICENSE (TEMPORARY)