KEVIN R WENTWORTH (NPI# 1639270069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639270069 |
| Entity Type | Individual |
| Full Name | KEVIN R WENTWORTH |
| Credential | MD |
| Practice Address |
1027 Washington Avenue Detroit Lakes MN 56501-3409 |
| Mailing Address |
415 Jefferson St North Tri-county Health Care Wadena MN 56482-1296 |
| Practice Telephone | 2188475611 |
| Mailing Telephone | 2186313510 |
| Mailing Fax Number | 2186317507 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2018-09-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 44499 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 274948 | 05 | |
| MN | UCAREMN | 169526 | 01 |
| MN | HEALTHPARTNERS | HP42348 | 01 |
| MN | PREFERREDONE | 1031036 | 01 |
| MN | 256961200 | 05 | |
| MN | MEDICA | 01-14159 | 01 |
| MN | BCBS | 074M7WE | 01 |
| ND | 11772 | 05 | |
| NE | 41091744413 | 05 | |
| WI | 82362200 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 401 Douglas Ave, Tri-county Health Care - Henning Clinic, Henning, MN 56551 | 2185832953 | 2186314521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215155056 | Kevin J. Wentworth | Physician Assistant | 111 Clara Barton St, Dansville, NY 14437-9503 | 2007-04-24 |
| Street Address |
1027 WASHINGTON AVENUE |
| City | DETROIT LAKES |
| State | MN |
| Zip Code | 56501-3409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548714876 | Bobi Lyn Spaeth | Social Worker | 1027 Washington Avenue, Detroit Lakes, MN 56501-3409 | 2016-08-03 |
| 1922407030 | Kristine Lea Stompro | Specialist/Technologist | 1027 Washington Avenue, Eh St Mary's-detroit Lakes Clinic Urgent Care, Detroit Lakes, MN 56501 | 2014-08-14 |
| 1457639601 | Travis David Swartz | Surgery | 1027 Washington Avenue, Eh St Mary's Detroit Lakes Clinic, Detroit Lakes, MN 56501-3904 | 2011-07-21 |
| 1043519796 | Gaurav Suresh Mehta | Family Medicine | 1027 Washington Avenue, Detroit Lakes, MN 56501-3409 | 2011-03-21 |
| 1669603403 | Anna Joy Neu | Nurse Practitioner | 1027 Washington Avenue, Detroit Lakes, MN 56501 | 2009-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265649 | Candace Louise Haugtvedt | Pharmacist | 321 Us-10 West, Detroit Lakes, MN 56501 | 2020-11-05 |
| 1679068407 | Strive Chiropractic Detroit Lakes LLC | Chiropractor | 1852 Nodaway Drive, Detroit Lakes, MN 56501 | 2018-06-25 |
| 1194215830 | Jordan James Reese | Registered Nurse | 1295 Bay Ridge Dr, Detroit Lakes, MN 56501 | 2018-05-17 |
| 1992179386 | Compassion House | Substance Abuse Rehabilitation Facility | 811 8th St. Se, Detroit Lakes, MN 56501 | 2015-11-23 |
| 1720344286 | Lakes Crisis & Resource Center | Clinic/Center | 1339 Pelican Lane, Detroit Lakes, MN 56501 | 2012-04-09 |
| 1063657120 | Diane Jean Mccormack | Occupational Therapist | 15840 Long Lake Road, Detroit Lakes, MN 56501 | 2008-12-03 |
| 1588817928 | Darcy Caleb Olson | Counselor | 925 Lake Ave, Detroit Lakes, MN 56501 | 2008-10-29 |
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1427274729 | Jeffrey C Gregory | Psychologist | 910 Lincoln Ave, Detroit Lakes, MN 56501 | 2007-04-17 |
| 1144364894 | Midwest Vision Centers Inc | Eyewear Supplier (Equipment, not the service) | 830 Washington Avenue, Detroit Lakes, MN 56501 | 2007-02-16 |
| Find all providers in zip 56501 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1104877455 | Dakota Clinic, Ltd. | Family Medicine | 125 Frazee St E, Detroit Lakes, MN 56501-3501 | 2006-05-12 |
| 1871582643 | Mark David Lindquist | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501 | 2005-10-14 |
| 1295268993 | Tricia Rae Brein | Family Medicine | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2017-04-10 |
| 1164978599 | Innovis Health LLC | Family Medicine | 1361 Wenner Rd, Detroit Lakes, MN 56501-7918 | 2016-08-26 |
| 1538513155 | Molly Marie Anderson | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2016-04-20 |
| 1639513377 | St Mary's Regional Health Center | Family Medicine | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2013-04-24 |
| 1376823674 | Sanford Medical Center Fargo | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2011-08-18 |
| 1043519796 | Gaurav Suresh Mehta | Family Medicine | 1027 Washington Avenue, Detroit Lakes, MN 56501-3409 | 2011-03-21 |
| 1235450982 | Charles Stephen Shaffer | Family Medicine | 1027 Washington Ave, Detroit Lakes, MN 56501 | 2010-06-17 |
| Find all providers in DETROIT LAKES | ||||
| City | DETROIT LAKES |
| Zip Code | 56501 |
Please comment or provide details below to improve the information on KEVIN R WENTWORTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.