Provider Demographics
NPI:1124016597
Name:KANZENBACH, TODD LAVERNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LAVERNE
Last Name:KANZENBACH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:600 MAYWOOD AVE
Mailing Address - Street 2:21 CARKOSKI COMMONS
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6441
Mailing Address - Country:US
Mailing Address - Phone:507-389-1430
Mailing Address - Fax:507-389-5787
Practice Address - Street 1:21 CARKOSKI COMMONS
Practice Address - Street 2:MINNESOTA STATE UNIVERSITY, MANKATO
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6030
Practice Address - Country:US
Practice Address - Phone:507-389-6276
Practice Address - Fax:507-389-5787
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-01-20
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Provider Licenses
StateLicense IDTaxonomies
MN38627207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-09557OtherMEDICA
MN247M1KAOtherBCBS
MN140293OtherUCARE
MN140293OtherUCARE