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Mark Iriwn Kampfe

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NPI Number Detailed Information

Provider Information:

Name: Mark Iriwn Kampfe
Gender: M
Provider License Number If Given: 5399

NPI Information:

NPI: 1760485965
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 8/5/2010

Provider Business Mailing Address:

Address: 2900 DOOLITTLE DR BLDG 6000 RM 1TB03 ELLSWORTH AFB
Ellsworth Afb, SD 57706
Phone Number: 6053853560
Fax Number: 6053853498

Provider Business Practice Location Address:

Address: 2900 DOOLITTLE DR BLDG 6000 RM 1TB03 ELLSWORTH AFB
Ellsworth Afb, SD 57706
Phone Number: 6053853560
Fax Number: 6053853498

Provider Taxonomy:

Primary: 1223G0001X
Secondary (if any): 1223G0001X
State: SD