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General NPI Number Information
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NPI Number | 1518946532
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Entity Type | Individual
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Provider Name | KIRK M ODDEN MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 221 S MURPHY ST
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City | LAKE CRYSTAL
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State | MN
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Zip | 56055-2128
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Country | US
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Telephone | 507-726-2136
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8674 1230 E MAIN ST
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City | MANKATO
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State | MN
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Zip | 56002-8674
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Country | US
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Telephone | 507-625-1811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27361
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 27361
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License Number State | MN
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