Provider Demographics
NPI:1770547598
Name:BJORDAHL, KEVIN L (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:BJORDAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14390 SD HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-5415
Mailing Address - Country:US
Mailing Address - Phone:605-949-0051
Mailing Address - Fax:
Practice Address - Street 1:803 E MILBANK AVE
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1413
Practice Address - Country:US
Practice Address - Phone:605-432-4587
Practice Address - Fax:605-432-4580
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN753278400Medicaid
SD5604166Medicaid
SD5604166Medicaid
AB1598715OtherDEA #
A02590Medicare UPIN