Individual
KELLY B FANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1900 CENTRACARE CIRCLE, CENTRACARE CLINIC - WOMENS & CHILDRENS, ST CLOUD, MN 56303-5000
(320) 654-3630
Mailing address
1900 CENTRACARE CIRCLE, CENTRACARE CLINIC - WOMENS & CHILDRENS, ST CLOUD, MN 56303-5000
(320) 654-3630
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
40924
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372219800
—
MN
Enumeration date
06/18/2006
Last updated
08/27/2008
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