Individual
KENNETH JOHN GUIDERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2025 E RIVER PKWY, MINNEAPOLIS, MN 55414-3604
(612) 596-6187
(612) 339-7634
Mailing address
P.O. BOX 209036, SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES, DALLAS, TX 75320-9036
(813) 281-8478
(813) 281-8113
Taxonomy
Speciality
Code
Description
License number
State
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
47329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158417100
—
MN
05
—
1922150697
—
MN
Enumeration date
01/16/2007
Last updated
04/04/2011
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