Wilson, Kent Shannon

Wilson, Kent Shannon is an individual health care provider with primary practice located at 2080 Woodwinds Drive #120, Woodbury MN 55125. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Wilson, Kent Shannon can be contacted via phone (651) 702-0750.

Contact Information

Primary practice address
2080 Woodwinds Drive #120 Woodbury MN 55125
Phone: (651) 702-0750
Fax: (651) 702-0749
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 17805 Minnesota
Allopathic & Osteopathic Physicians / Surgery 208600000X 17805 Minnesota

Profile Details

NPI number 1922044288
LBN Legal business name Wilson, Kent Shannon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Dec 4th, 2009 - about 17 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 1922044288 NPPES
Minnesota MEDICAID 905070100

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