Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 33505 | MN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 33505 | MN |
NPI | 1457377657 |
---|---|
Provider Name | Dr. Kurt M Devine |
First Address | Sartell, MN 56377-4645 |
Second Address | Sartell, MN 56377-4645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 15/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0120122 | MEDICA (01) | |
080056694 | RR MEDICARE (01) | |
097702100 | (05) | MN |
107207C736 | UCARE MINNESOTA (01) | MN |
28638DE | BCBS OF MINNESOTA (01) | MN |
A003 | TRICARE (01) | MN |
E11322 | (02) | |
HP10317 | HEALTH PARTNERS (01) | |
NA9230454502 | PREFERRED ONE (01) |