Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 29139 | MN |
NPI | 1124043229 |
---|---|
Provider Name | Dr. John D Kolstoe |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Bemidji, MN 56601-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A79296 | (02) | MI |