MEDICARE: KATHY BUXTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174470001	OTHER	MN	PTAN

General Provider Information

NPI Number	:	1447624929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY BUXTON

Provider Business Mailing Address
First Line	:	1054 GREEN GABLES RD
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-3167
Country	:	US
Telephone Number	:	218-829-8109
Fax Number	:	218-829-8109

Provider Business Practice Location Address
First Line	:	1054 GREEN GABLES RD
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-3167
Country	:	US
Telephone Number	:	218-829-8109
Fax Number	:	218-829-8109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/20/2015

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