Healthcare Provider Details

I. General information

NPI: 1982969614
Provider Name (Legal Business Name): KRISTI LYNN KLETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 INDIGO DR
EDEN PRAIRIE MN
55347-1208
US

IV. Provider business mailing address

10150 INDIGO DR
EDEN PRAIRIE MN
55347-1208
US

V. Phone/Fax

Practice location:
  • Phone: 952-938-2377
  • Fax: 952-938-2377
Mailing address:
  • Phone: 952-938-2377
  • Fax: 952-938-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number23572
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: