Provider Demographics
NPI:1104808534
Name:KAMMER, C. SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:C. SCOTT
Middle Name:
Last Name:KAMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:SCOTT
Other - Last Name:KAMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 STINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2615
Mailing Address - Country:US
Mailing Address - Phone:612-294-5826
Mailing Address - Fax:612-884-2465
Practice Address - Street 1:500 STINSON BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2615
Practice Address - Country:US
Practice Address - Phone:612-294-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080020930Medicare PIN