Individual
KIRK M ODDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
221 S MURPHY ST, LAKE CRYSTAL, MN 56055-2128
(507) 726-2136
Mailing address
PO BOX 8674, 1230 E MAIN ST, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27361
MN
207QG0300X
Geriatric Medicine (Family Medicine) Physician
27361
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0116026
MEDICA
MN
01
—
080068437
RR MEDICARE
MN
01
—
080068437
RR MEDICARE
—
01
—
115441
UCARE
MN
01
—
1973693
IOWA MA
—
05
—
1973693
—
IA
01
—
26097
AMERICAS PPO
MN
01
—
3T990OD
BCBS
MN
01
—
41084933956001C008
CHAMPUS
—
01
—
41084933956001C088
CHAMPUS
—
01
—
95124
BCBS
IA
05
—
993067100
—
MN
01
—
HP25875
HEALTH PARTNERS
MN
01
—
NA2951010486
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
07/15/2020
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