Healthcare Provider Details

I. General information

NPI: 1548222458
Provider Name (Legal Business Name): KENNETH M FLOWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

IV. Provider business mailing address

18 WIMBLEDON DR
ROXBORO NC
27573-4883
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4543
  • Fax:
Mailing address:
  • Phone: 843-237-3378
  • Fax: 843-237-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9300114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: