Healthcare Provider Details

I. General information

NPI: 1306306568
Provider Name (Legal Business Name): KEVIN DUH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH SCIENCE TOWER LEVEL 19, ROOM 030
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

915 E 1ST ST
DULUTH MN
55805-2107
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number83214
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: