Individual
KEVIN R WENTWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1027 WASHINGTON AVENUE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
Mailing address
415 JEFFERSON ST NORTH, TRI-COUNTY HEALTH CARE, WADENA, MN 56482-1296
(218) 631-3510
(218) 631-7507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44499
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-14159
MEDICA
MN
01
—
074M7WE
BCBS
MN
01
—
1031036
PREFERREDONE
MN
05
—
11772
—
ND
01
—
169526
UCAREMN
MN
05
—
256961200
—
MN
05
—
274948
—
OR
05
—
41091744413
—
NE
05
—
82362200
—
WI
01
—
HP42348
HEALTHPARTNERS
MN
Enumeration date
09/26/2006
Last updated
04/30/2024
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