KENNETH J. MARTIN (NPI# 1669688057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669688057 |
| Entity Type | Individual |
| Full Name | KENNETH J. MARTIN |
| Other Name | DR. KENNETH J. MARTIN |
| Credential | M.D. |
| Practice Address |
610 30th Ave W Alexandria MN 56308-3426 |
| Practice Telephone | 3207635123 |
| Practice Fax Number | 3207637883 |
| Mailing Telephone | 3207635123 |
| Mailing Fax Number | 3207637883 |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2017-01-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | MT188409 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | DEA | FM6502238 | 01 |
| MN | TEMP LICENSE | 109461 | 01 |
| MN | NPI | 1669688057 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285232579 | Kenneth Martin | Technician | 138 Ivy Rd, Lerona, WV 25971 | 2020-10-09 |
| 1467085274 | Kenneth Martin | Pharmacist | 1811 West Govt St, Brandon, MS 39042-2106 | 2020-02-20 |
| 1578122065 | Kenneth Kevin Martin | Pharmacist | 700 Scott and White Dr # 1.112, College Station, TX 77845-6441 | 2019-06-10 |
| 1598064677 | Kenneth Martin | Physician Assistant | 26 Edgerton Drive, North Falmouth, MA 02556 | 2011-03-15 |
| 1154475952 | Kenneth Michael Martin | Physical Therapist | 2700 Lake Villa Dr Ste 100, Metairie, LA 70002-6782 | 2007-01-22 |
| 1760557334 | Kenneth R. Martin | Dentist | 694 S Willow Ave, Cookeville, TN 38501-3882 | 2006-11-21 |
| 1093899007 | Kenneth Leon Martin | Counselor | 105 Paces Brook Ave, #10518, Columbia, SC 29212-1642 | 2006-10-25 |
| 1245261809 | Kenneth J Martin | Marriage & Family Therapist | 564 Market St, Suite 410, San Francisco, CA 94104-5404 | 2006-07-05 |
| 1093743858 | Kenneth Martin Jr. | Audiologist | 710 N High St, Longview, TX 75601-5330 | 2006-06-29 |
| 1699730689 | Kenneth Andrew Martin | Orthopaedic Surgery | 5320 W. Markham, Little Rock, AR 72205 | 2006-04-20 |
| Street Address |
610 30TH AVE W |
| City | ALEXANDRIA |
| State | MN |
| Zip Code | 56308-3426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528066651 | Lake Region Eye Center | Optometrist | 610 30th Ave W, Ste 200, Alexandria, MN 56308-3426 | 2005-07-12 |
| 1760005433 | Andrea L Swenson | Registered Nurse | 610 30th Ave W, Alexandria, MN 56308-3426 | 2020-05-28 |
| 1396206959 | Brooke Ann Loeffler | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308-3426 | 2019-03-27 |
| 1427515287 | Tara Allison Reichmann | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308-3426 | 2019-02-27 |
| 1457816027 | Alomere Health | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308 | 2019-02-07 |
| 1306315486 | Maxwell Alan Berscheit | Nurse Practitioner | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-11-18 |
| 1598240376 | Connor William Sacks | Physician Assistant | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-09-27 |
| 1164905659 | Samantha Jean Aabel | Advanced Practice Midwife | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-09-11 |
| 1861970592 | Kelly Jean Mahoney | Physician Assistant | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-08-03 |
| 1205365830 | Skyler Holte Dahlseng | Internal Medicine | 610 30th Ave W, Alexandria, MN 56308-3426 | 2017-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871104836 | Center for Pain Management Ambulatory Surgery, Ltd | Pain Medicine | 804 23rd Street South, Sartell, MN 56308 | 2020-08-13 |
| 1548815590 | Ritajo Ellenberger | Licensed Practical Nurse | 220 Oak Street North, Alexandria, MN 56308 | 2019-08-06 |
| 1346808714 | Vance Thompson Vision Surgery Center Alexandria, Prof LLC | Clinic/Center | 2600 Jefferson St, Alexandria, MN 56308 | 2019-05-31 |
| 1811452048 | Little Falls Eye Care Center Pa | Optometrist | 2306 S. Broadway Str. Suite 12, Alexandria, MN 56308 | 2019-02-01 |
| 1184167199 | Jennifer Lynn Craig | Technician | 2307 East Golf Course Rd, Alexandria, MN 56308 | 2016-11-22 |
| 1548712219 | Shelby Elisha Johnsrud | Chiropractor | 303 West 22nd Ave, Ste 100, Alexandria, MN 56308 | 2016-10-28 |
| 1811347867 | Dustin Matthew Ditch | Dentist | 510 22nd Ave E Ste 702, Alexandria, MN 56308 | 2016-06-20 |
| 1639538051 | West Central Chiropractic & Wellness, LLC | Chiropractor | 123 3rd Ave. E, Suite 100, Alexandria, MN 56308 | 2016-02-12 |
| 1659736221 | Amanda Jean Dahlseng | Registered Nurse | 809 Elm Street, Suite 1200, Alexandria, MN 56308 | 2015-12-23 |
| 1518358886 | Benjamin G Wenzel | Marriage & Family Therapist | 512 30th Ave S, Ste 100, Alexandria, MN 56308 | 2015-02-09 |
| Find all providers in zip 56308 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205454774 | Jackson Street Pediatrics, LLC | Pediatrics | 5716 Jackson St, Alexandria, LA 71303-2042 | 2020-07-10 |
| 1205221942 | Carlos A. Cruz, Md, PC | Pediatrics | 1707 Osage St Ste 303, Alexandria, VA 22302-2611 | 2015-03-31 |
| 1447508163 | Arnold Jay Zedd | Pediatrics | 2621 Jamestown Lane, #203, Alexandria, VA 22314-5882 | 2012-08-28 |
| 1104102987 | Reynaldo Fraga | Pediatrics | 4518 Seminary Road, Juan R. Fraga M.d., Alexandria, VA 22304 | 2011-10-25 |
| 1144417544 | Chandanjeet Sidhu | Pediatrics | 2616 Sherwood Hall Ln Ste 106, Alexandria, VA 22306-3154 | 2007-09-29 |
| 1780886481 | Cathy Southammakosane | Pediatrics | 1500 N Beauregard St Ste 200, Alexandria, VA 22311-1700 | 2007-06-04 |
| 1215156898 | Rhodes Pediatric Clinic | Pediatrics | 37 Calvert Dr, Alexandria, LA 71303-3520 | 2007-04-24 |
| 1346363769 | Robert Bregman | Pediatrics | 4480 King St., Alex Health Dept, Alexandria, VA 22302 | 2007-04-09 |
| 1013035575 | Emily B Remus | Pediatrics | 1451 Belle Haven Rd Ste 110, Alexandria, VA 22307-1201 | 2007-03-26 |
| 1598880791 | Terri W Cummings | Pediatrics | 3628 Ransom Pl, Alexandria, VA 22306-1473 | 2007-03-20 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 56308 |
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| 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.