Provider Demographics
NPI:1982618674
Name:ARCILLA, KRISTEL L (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:L
Last Name:ARCILLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 2ND ST SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3365
Mailing Address - Country:US
Mailing Address - Phone:320-235-7232
Mailing Address - Fax:320-231-8602
Practice Address - Street 1:502 2ND ST SW
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3365
Practice Address - Country:US
Practice Address - Phone:320-235-7232
Practice Address - Fax:320-231-8602
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00438365OtherRR MEDICARE PTAN
MN378687000Medicaid
MN01-25341OtherMEDICA
MN153H1AROtherBCBSMN
MN080015219Medicare ID - Type Unspecified
MNI58981Medicare UPIN