Provider Demographics
NPI:1386647980
Name:KAMP, DANIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIA
Middle Name:A
Last Name:KAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4570 CTY. HWY. 61
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767
Mailing Address - Country:US
Mailing Address - Phone:218-485-4491
Mailing Address - Fax:218-485-4724
Practice Address - Street 1:4570 CTY. HWY. 61
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767
Practice Address - Country:US
Practice Address - Phone:218-485-4491
Practice Address - Fax:218-485-4724
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN315471800Medicaid
MN315471800Medicaid
MN080013728Medicare PIN
MNI22588Medicare UPIN