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NPI Code Detail

MEDICARE: DR. KELLY GAIL KINNAN M.D.

MEDICARE: DR. KELLY GAIL KINNAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician47793MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080016114OTHERMNMEDICARE-WPS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2094H0SWOTHERMNBCBS OF MN
32435604OTHERMNAMERICA'S PPO
4HP61506OTHERMNHEALTHPARTNERS
51014268OTHERMNPREFERRED ONE
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
76609467OTHERMNMEDICA UC# FOR APC

General Provider Information

NPI Number : 1013969518
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY GAIL KINNAN M.D.
Provider Business Mailing Address
First Line : 1700 HIGHWAY 25 N
Second Line :
City : BUFFALO
State : MN
Zip : 55313-1930
Country : US
Telephone Number : 763-682-1313
Fax Number :
Provider Business Practice Location Address
First Line : 1700 HIGHWAY 25 N
Second Line :
City : BUFFALO
State : MN
Zip : 55313-1930
Country : US
Telephone Number : 763-682-1313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 09/29/2008

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