=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972794865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KURT ALAN HABBEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 10/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W 1ST ST
-----------------------------------------------------
City | PAYNESVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56362-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-243-3767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W 1ST ST
-----------------------------------------------------
City | PAYNESVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56362-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-243-3767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 50838
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------