Healthcare Provider Details

I. General information

NPI: 1952505448
Provider Name (Legal Business Name): KATHLEEN PFISTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MMC 39
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

2450 RIVERSIDE AVE EAST BLDG, MB 630
MINNEAPOLIS MN
55454-1450
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-0644
  • Fax:
Mailing address:
  • Phone: 612-626-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number52860
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: