1386900272 NPI number — KYLE ROBERT HAMRE CERTIFIED PROSTHETIS

Table of content: KYLE ROBERT HAMRE CERTIFIED PROSTHETIS (NPI 1386900272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386900272 NPI number — KYLE ROBERT HAMRE CERTIFIED PROSTHETIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMRE
Provider First Name:
KYLE
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED PROSTHETIS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386900272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 DAHLBERG DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-4840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-512-5600
Provider Business Mailing Address Fax Number:
952-512-5651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE 162
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-929-1051
Provider Business Practice Location Address Fax Number:
952-929-9641
Provider Enumeration Date:
04/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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