Healthcare Provider Details

I. General information

NPI: 1134203706
Provider Name (Legal Business Name): KEVIN K STILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 HIGHWAY 23 FOLEY MEDICAL CENTER
FOLEY MN
56329-0218
US

IV. Provider business mailing address

471 HIGHWAY 23 FOLEY MEDICAL CENTER
FOLEY MN
56329-0218
US

V. Phone/Fax

Practice location:
  • Phone: 320-968-7234
  • Fax: 320-968-7237
Mailing address:
  • Phone: 320-968-7234
  • Fax: 320-968-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34689
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: