Healthcare Provider Details

I. General information

NPI: 1275732455
Provider Name (Legal Business Name): DAVID A KUYLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

IV. Provider business mailing address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4000
  • Fax: 701-456-4800
Mailing address:
  • Phone: 701-456-4000
  • Fax: 701-456-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPT10536
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: