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Individual

KEVIN J BARDWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
13060 ISLE DR, BAXTER, MN 56425-8331
(218) 828-2880
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36003
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0118449
MEDICA
MN
05
0572149
IA
01
080163236
RR MEDICARE
01
105085
UCARE
MN
05
204283500
MN
01
21851
AMERICAS PPO
MN
05
32013500
WI
01
41084933956001C072
CHAMPUS
01
62B41BA
BCBS
MN
01
HP15832
HEALTH PARTNERS
MN
01
NA2951006282
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
07/08/2019
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