MEDICARE: KIRK M ODDEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	27361	MN
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	27361	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080068437	OTHER		RR MEDICARE
5	080068437	OTHER	MN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3T990OD	OTHER	MN	BCBS
3	41084933956001C088	OTHER		CHAMPUS
4	HP25875	OTHER	MN	HEALTH PARTNERS
6	41084933956001C008	OTHER		CHAMPUS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0116026	OTHER	MN	MEDICA
9	1973693	OTHER		IOWA MA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	95124	OTHER	IA	BCBS
12	26097	OTHER	MN	AMERICAS PPO
13	115441	OTHER	MN	UCARE
14	NA2951010486	OTHER	MN	PREFERRED ONE

General Provider Information

NPI Number	:	1518946532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK M ODDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 8674
Second Line	:	1230 E MAIN ST
City	:	MANKATO
State	:	MN
Zip	:	56002-8674
Country	:	US
Telephone Number	:	507-625-1811
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 S MURPHY ST
Second Line	:
City	:	LAKE CRYSTAL
State	:	MN
Zip	:	56055-2128
Country	:	US
Telephone Number	:	507-726-2136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/15/2020

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Directions to “ KIRK M ODDEN MD” Practice Location

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