Individual
KELLY SMUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 624-4477
Mailing address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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