Individual
MR. ANTHONY KEVIN MUIDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3165 DEMERS AVE - TRUYU AESTHETIC CENTER, GRAND FORKS, ND 58201
(701) 780-6623
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
(701) 780-1942
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
10458
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34199500
—
WI
Enumeration date
09/21/2005
Last updated
02/26/2019
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