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General NPI Number Information
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NPI Number | 1922388123
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Entity Type | Organization
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Legal Business Name | TE DEO, LLC
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 627 12TH ST E
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City | GLENCOE
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State | MN
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Zip | 55336-2133
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Country | US
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Telephone | 320-864-8000
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Fax | 320-864-8004
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Provider Business Mailing Address
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Address Line | 10374 155TH ST
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City | GLENCOE
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State | MN
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Zip | 55336-7502
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Country | US
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Telephone | 612-240-0054
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KURT DONALD KRAMER
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Credential | STM, DC
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Telephone | 612-240-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 5391
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License Number State | MN
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