Individual
KENT MICHAEL PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
717 S STATE ST, SUITE 900, FAIRMONT, MN 56031-4469
(507) 238-4949
(507) 238-3377
Mailing address
717 S STATE ST, SUITE 900, FAIRMONT, MN 56031-4469
(507) 238-4949
(507) 238-3377
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
C041516
CA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
103500
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C415160
—
CA
01
—
154N4PA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
12/12/2006
Last updated
01/30/2008
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