Healthcare Provider Details

I. General information

NPI: 1831269745
Provider Name (Legal Business Name): KEVIN FLOYD FOLKERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CBOC BISMARCK GATEWAY MALL 2700 STATE ST.
BISMARCK ND
58503
US

IV. Provider business mailing address

2043 N BELL ST
BISMARCK ND
58501-1584
US

V. Phone/Fax

Practice location:
  • Phone: 701-221-9152
  • Fax: 701-221-0918
Mailing address:
  • Phone: 701-255-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5353
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: