Healthcare Provider Details

I. General information

NPI: 1578668174
Provider Name (Legal Business Name): KATHRYN E DUSENBERY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HARVARD ST SE UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 494 MMUNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-6700
  • Fax:
Mailing address:
  • Phone: 612-273-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number29219
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number29219
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number29219
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: