Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0000578 | MN |
NPI | 1316912801 |
---|---|
Provider Name | Steven J Kavros |
First Address | Edina, MN 55435-5936 |
Second Address | Edina, MN 55435-5936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 19/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480020787 | RAILROAD MEDICARE (01) | MN |
656356200 | (05) | MN |
T77765 | (02) |