Healthcare Provider Details

I. General information

NPI: 1619969029
Provider Name (Legal Business Name): GREGORY J KUIPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SIOUX VALLEY DRIVE
LUVERNE MN
56156
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 507-283-4476
  • Fax: 507-283-9086
Mailing address:
  • Phone: 605-328-9556
  • Fax: 605-328-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34407
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: