Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6800 | MN |
Y | 213EG0000X | General Practice | 6800 | MN |
NPI | 1003052770 |
---|---|
Provider Name | Kenneth Donald Salo |
First Address | Champlin, MN 55316-2513 |
Second Address | Champlin, MN 55316-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 30/12/2008 |