Healthcare Provider Details

I. General information

NPI: 1770547598
Provider Name (Legal Business Name): KEVIN L BJORDAHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 E MILBANK AVE
MILBANK SD
57252-1413
US

IV. Provider business mailing address

14390 SD HIGHWAY 15
MILBANK SD
57252-5415
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-4587
  • Fax: 605-432-4580
Mailing address:
  • Phone: 605-949-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1589
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: