Individual
REID KENNETH MIMMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3000
Mailing address
9236 QUEENS GARDEN NORTH, BROOKLYN PARK, MN 55443
(218) 330-4969
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
79473
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2021
Last updated
07/03/2025
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