Individual
DR. TODD LAVERNE KANZENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 CARKOSKI COMMONS, MINNESOTA STATE UNIVERSITY, MANKATO, MANKATO, MN 56001-6030
(507) 389-6276
(507) 389-5787
Mailing address
600 MAYWOOD AVE, 21 CARKOSKI COMMONS, MANKATO, MN 56001-6441
(507) 389-1430
(507) 389-5787
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
38627
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-09557
MEDICA
MN
01
—
140293
UCARE
MN
01
—
247M1KA
BCBS
MN
Enumeration date
10/11/2005
Last updated
01/20/2022
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