Active NPI
Melissa Kizilos, MD
- Internal Medicine Physician
- Eagan, MN
National Provider Identifier
1508336835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 38101
- Practice address
- 3535 Blue Cross Rd
Eagan, MN 55122-1154 - Phone
- (952) 412-7468
- NPI assigned
- Nov 29, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 38101 | MN | Primary |
Addresses
Primary practice location
3535 Blue Cross Rd
Eagan, MN 55122-1154
Mailing address
5864 Stoneybrook Dr
Minnetonka, MN 55345-6433
Phone (952) 412-7468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38101 | MN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543449600000",
"number": "1508336835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5864 STONEYBROOK DR",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553456433",
"telephone_number": "952-412-7468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 BLUE CROSS RD",
"city": "EAGAN",
"state": "MN",
"postal_code": "551221154",
"telephone_number": "952-412-7468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIZILOS",
"first_name": "MELISSA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-29",
"last_updated": "2018-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "38101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.