Individual
DONALD WAYNE KJOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
967 LAKE ST S, FOREST LAKE, MN 55025-2616
(651) 464-1113
(651) 464-0853
Mailing address
967 LAKE ST S, FOREST LAKE, MN 55025-2616
(651) 464-1113
(651) 464-0853
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22028
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195588800
—
MN
Enumeration date
10/26/2006
Last updated
03/17/2018
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