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Individual

KENNETH J. MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-7883
Mailing address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-7883

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MT188409
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
109461
TEMP LICENSE
MN
01
1669688057
NPI
MN
Enumeration date
05/15/2007
Last updated
03/07/2023
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