Provider Demographics
NPI:1134203706
Name:STILES, KEVIN K (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:STILES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:471 HIGHWAY 23
Mailing Address - Street 2:FOLEY MEDICAL CENTER
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-0218
Mailing Address - Country:US
Mailing Address - Phone:320-968-7234
Mailing Address - Fax:320-968-7237
Practice Address - Street 1:471 HIGHWAY 23
Practice Address - Street 2:FOLEY MEDICAL CENTER
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-0218
Practice Address - Country:US
Practice Address - Phone:320-968-7234
Practice Address - Fax:320-968-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-05-26
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Provider Licenses
StateLicense IDTaxonomies
MN34689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0128557OtherMEDICA
MN996065100Medicaid
MN2T846STOtherBCBS
MN0128557OtherMEDICA
MNE97475Medicare UPIN