Individual
MR. KENRIC D MALMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 22ND AVE, BROOKINGS, SD 57006-2497
(605) 697-9500
(605) 697-6939
Mailing address
400 22ND AVE, BROOKINGS, SD 57006-2497
(605) 697-9500
(605) 697-6939
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7340A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4992950
BLUE SHIELD
SD
05
—
5612920
—
SD
Enumeration date
06/11/2006
Last updated
06/26/2014
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