Individual
KEVIN L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1990 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 257-5595
(320) 257-5596
Mailing address
PO BOX 7366, SAINT CLOUD, MN 56302-7366
(320) 257-5595
(320) 257-5596
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
42088
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128440C561
UCARE OF MINNESOTA
MN
01
—
16-02418
MEDICA
MN
01
—
300138882
RAILROAD MEDICARE
MN
01
—
411772562
TRICARE
MN
05
—
627622900
—
MN
01
—
67G97SM
BLUE CROSS BLUE SHIELD
MN
01
—
883131
ARAZ/ AMERICA'S PPO
MN
01
—
965251022160
PREFERRED ONE
MN
01
—
HP38324
HEALTH PARTNERS
MN
Enumeration date
07/28/2005
Last updated
08/11/2011
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