Healthcare Provider Details

I. General information

NPI: 1043379571
Provider Name (Legal Business Name): KATHRYN LYNN FISCHER, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 PRAIRIE CENTER DR #135-292
EDEN PRAIRIE MN
55344-7930
US

IV. Provider business mailing address

574 PRAIRIE CENTER DR #135-292
EDEN PRAIRIE MN
55344-7930
US

V. Phone/Fax

Practice location:
  • Phone: 612-710-3671
  • Fax: 763-295-4946
Mailing address:
  • Phone: 612-710-3671
  • Fax: 763-295-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47326
License Number StateMN

VIII. Authorized Official

Name: KATHRYN LYNN FISCHER
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 612-710-3671