Provider Demographics
NPI:1376585059
Name:POSSAI, KURT W (DO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:POSSAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SANFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2700
Mailing Address - Country:US
Mailing Address - Phone:218-683-2725
Mailing Address - Fax:218-683-2725
Practice Address - Street 1:3001 SANFORD PKWY
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2700
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43229207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0900330OtherMEDICA #
MN142048OtherUCARE #
MN19484OtherNDBS #
MN92D03POOtherMNBS #
FM98D09POOtherMNBS #
MN1154017OtherAMERICA'S PPO/ARAZ #
MN11858Medicaid
MNMN200034OtherLHS/BANNERHEALTH #
MN0900335OtherMEDICA #
MN901452700Medicaid
MNDA9021026992OtherPREFERRED ONE #
MNDA9071026992OtherPREFERRED ONE #
MNHP38401OtherHEALTHPARTNERS #
MNDA9021026992OtherPREFERRED ONE #
MN92D03POOtherMNBS #
MN0900330OtherMEDICA #
MNG02096Medicare UPIN
MN19484OtherNDBS #
MN200002675Medicare PIN