Individual
DERIK K KENWORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3600 MINNESOTA DR STE 800, EDINA, MN 55435-7915
(952) 595-1100
(612) 294-4903
Mailing address
3600 MINNESOTA DR STE 800, EDINA, MN 55435-7915
(952) 595-1100
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
05-50096
KS
2085R0202X
Diagnostic Radiology Physician
14225604-1204
UT
2085R0202X
Diagnostic Radiology Physician
Primary
DO220167
OR
2085R0202X
Diagnostic Radiology Physician
DR.0074105
CO
2085R0202X
Diagnostic Radiology Physician
MED-PHYS-LIC-148473
MT
2085R0202X
Diagnostic Radiology Physician
OS21657
FL
2085R0202X
Diagnostic Radiology Physician
V3891
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503865
—
AZ
01
—
Z173125
MEDICARE PTAN
—
Enumeration date
09/22/2009
Last updated
03/09/2026
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