Individual
KEVIN WAHLBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
55123 W GRINDSTONE RD, SANDSTONE, MN 55072-2692
(320) 385-4477
(320) 216-7638
Mailing address
55123 W GRINDSTONE RD, SANDSTONE, MN 55072-2692
(320) 385-4477
(320) 216-7638
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
Y275218560914
MN
Other
Enumeration date
07/22/2026
Last updated
07/22/2026
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