Individual
KYLE R CEDERMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(952) 826-8400
Mailing address
9400 ZANE AVE N, BROOKLYN PARK, MN 55443-1814
(763) 762-8800
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
54067
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
06/25/2010
Last updated
09/14/2020
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