Wentworth, Kevin R

Wentworth, Kevin R is an individual health care provider with primary practice located at 1027 Washington Avenue , Detroit Lakes MN 56501-3409. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wentworth, Kevin R can be contacted via phone (218) 847-5611.

Contact Information

Primary practice address
1027 Washington Avenue Detroit Lakes MN 56501-3409
Phone: (218) 847-5611
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 44499 Minnesota

Profile Details

NPI number 1639270069
LBN Legal business name Wentworth, Kevin R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2006
Last updated Apr 30th, 2024 - about last year

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 1639270069 NPPES
Oregon MEDICAID 274948
Oregon Other HP42348
Oregon Other 074M7WE
Oregon Other 1031036
Oregon Other 01-14159
Oregon MEDICAID 41091744413
Oregon MEDICAID 82362200
Oregon MEDICAID 11772
Oregon MEDICAID 256961200
Oregon Other 169526

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