1528138450 NPI number — DR. KATHLEEN V WATSON MD

Table of content: DR. KATHLEEN V WATSON MD (NPI 1528138450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528138450 NPI number — DR. KATHLEEN V WATSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
KATHLEEN
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528138450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERISITY OF MINNESOTA PHYSICIANS
Provider Second Line Business Mailing Address:
420 DELAWARE STREET SE, MMC 741
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-884-0999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERISITY OF MINNESOTA PHYSICIANS
Provider Second Line Business Practice Location Address:
516 DELAWARE STREET SE, CLINIC 3A
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-884-0999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25764 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0000X , with the licence number: 25764 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 737872600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000062 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0402803 . This is a "MEDICA - PRIMARY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0402804 . This is a "MEDICA - CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 768402 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101529 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2T190WA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP22152 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0500611 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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