Provider Demographics
NPI:1124137567
Name:KINNEAR, EARL T (SFNP)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:T
Last Name:KINNEAR
Suffix:
Gender:M
Credentials:SFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34239 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-9394
Mailing Address - Country:US
Mailing Address - Phone:320-845-2479
Mailing Address - Fax:
Practice Address - Street 1:320 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9363
Practice Address - Country:US
Practice Address - Phone:320-845-2157
Practice Address - Fax:320-845-6138
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN37994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00F93KIOtherBLUE CROSS
MN1010080OtherPREFERRED ONE
MNMEDICAOtherMEDICA
MNP00216775OtherRAIL ROAD MC
MN110375OtherUCARE
MNHP10762OtherHEALTH PARTNERS
MNMEDICAOtherMEDICA