Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1535 | MN |
NPI | 1861539777 |
---|---|
Provider Name | Kenwood Merlyn Rund |
First Address | Glencoe, MN 55336-2206 |
Second Address | Glencoe, MN 55336-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |