Individual
KEVIN M WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4695 SHORELINE DR, SPRING PARK, MN 55384-9715
(952) 442-7895
(952) 442-7894
Mailing address
4695 SHORELINE DR, SPRING PARK, MN 55384-9715
(952) 442-7895
(952) 442-7894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
40200
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40200
DO LICENSE
MN
05
—
677015100
—
MN
Enumeration date
07/21/2005
Last updated
03/16/2010
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