Individual
DR. KENT WILLADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 RISEN SON BLVD, COUNCIL BLUFFS, IA 51503-1910
(712) 256-8600
(712) 256-8599
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 351-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20182
NE
207Q00000X
Family Medicine Physician
Primary
32302
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780795895
—
IA
Enumeration date
08/31/2006
Last updated
12/17/2013
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