MEDICARE: DR. PAUL RICHARD KINDAMO D.O.

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
1	207P00000X	Emergency Medicine Physician	31651	MN

General Provider Information

NPI Number	:	1144210071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL RICHARD KINDAMO D.O.

Provider Business Mailing Address
First Line	:	47488 BOWSTRING LAKE RD
Second Line	:
City	:	DEER RIVER
State	:	MN
Zip	:	56636-2457
Country	:	US
Telephone Number	:	218-362-6621
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 E 34TH ST
Second Line	:
City	:	HIBBING
State	:	MN
Zip	:	55746-3522
Country	:	US
Telephone Number	:	218-362-6621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2005
Last Update Date	:	07/08/2007

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