Provider Demographics
NPI:1982807350
Name:SMITH, KENNETH M (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:SMITH
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Gender:
Credentials:MD
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Mailing Address - Street 1:1805 HENNEPIN AVE N
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1416
Mailing Address - Country:US
Mailing Address - Phone:320-864-3121
Mailing Address - Fax:320-864-7892
Practice Address - Street 1:1805 HENNEPIN AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1416
Practice Address - Country:US
Practice Address - Phone:320-864-3121
Practice Address - Fax:320-864-7892
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2025-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN19785208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology