Cedermark, Kyle R

Cedermark, Kyle R is an individual health care provider with primary practice located at 12915 63Rd Ave N , Maple Grove MN 55369-6001. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Cedermark, Kyle R can be contacted via phone (952) 826-8400.

Contact Information

Primary practice address
12915 63Rd Ave N Maple Grove MN 55369-6001
Phone: (952) 826-8400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 54067 Minnesota

Profile Details

NPI number 1932410743
LBN Legal business name Cedermark, Kyle R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2010
Last updated Sep 14th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932410743 NPPES
Minnesota MEDICAID ENROLLED

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