Provider Demographics
NPI:1881664605
Name:BRITTON, KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BRITTON
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 1:1440 DUCKWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1451
Mailing Address - Country:US
Mailing Address - Phone:651-225-1102
Mailing Address - Fax:612-977-1208
Practice Address - Street 1:1440 DUCKWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1451
Practice Address - Country:US
Practice Address - Phone:651-225-1102
Practice Address - Fax:612-977-1208
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN824782000Medicaid
MN824782000Medicaid
MN250000524Medicare ID - Type Unspecified