Healthcare Provider Details

I. General information

NPI: 1679549992
Provider Name (Legal Business Name): JON R KEMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E FAIRVIEW AVE
OLIVIA MN
56277-4213
US

IV. Provider business mailing address

611 E FAIRVIEW AVE
OLIVIA MN
56277-4213
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-1460
  • Fax: 320-523-1703
Mailing address:
  • Phone: 320-523-1460
  • Fax: 320-523-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37158
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: