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Individual

KYLE J. SMISEK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1645 LYNDALE AVE N STE 103, FARIBAULT, MN 55021-2935
(507) 334-1601
Mailing address
704 NEVADA ST, NORTHFIELD, MN 55057-2600

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
12563
MN

Other

Enumeration date
11/20/2017
Last updated
11/20/2017
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