Healthcare Provider Details

I. General information

NPI: 1750776530
Provider Name (Legal Business Name): BENJAMIN ANDREW KITT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 17TH AVE E
ALEXANDRIA MN
56308-5273
US

IV. Provider business mailing address

111 17TH AVE E
ALEXANDRIA MN
56308-3798
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1511
  • Fax: 320-762-6070
Mailing address:
  • Phone: 320-762-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number65106
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: